Pub Date : 2023-03-03DOI: 10.1017/S1460396923000092
Ahmed A. Al-Balushi, M. Cain, Phil Reynolds, P. Bridge
Abstract Introduction: UroLift implants are a novel treatment for the obstructive lower urinary tract symptoms arising from benign prostatic hyperplasia. This case study aimed to assess their effectiveness as fiducial marker (FM) surrogates in prostate image-guided radiotherapy (IGRT). Method: Cone-beam CT images from a patient receiving prostate radiation therapy underwent manual alignment using UroLift implants and also prostate soft-tissue matching by five experienced therapeutic radiographers. The match values of both methods were compared using Bland–Altman analysis. All five observers were also asked to score the ease of matching using both approaches. Results: The 95% mean level of agreement for the UroLift matches were within a 2-mm threshold in all dimensions. Comparison of UroLift and prostate matches had 95% limit of agreement values of −0·98 to 1·78, −0·58 to 0·49 and −1·83 to 1·04 mm in the vertical, longitudinal and lateral planes, respectively. All of the UroLift matches were rated as ‘very easy’ or ‘possible with little difficulty’ by the five observers. Conclusion: A small difference between the CBCT UroLift and CBCT prostate match was found. It has been shown that IGRT to the prostate with the aid of the UroLift system implants and CBCT is feasible and can eliminate the need for FM implants. Wider evaluation in a large cohort is recommended.
{"title":"UroLift implants as surrogate fiducial markers for cone-beam CT-based prostate image-guided radiotherapy","authors":"Ahmed A. Al-Balushi, M. Cain, Phil Reynolds, P. Bridge","doi":"10.1017/S1460396923000092","DOIUrl":"https://doi.org/10.1017/S1460396923000092","url":null,"abstract":"Abstract Introduction: UroLift implants are a novel treatment for the obstructive lower urinary tract symptoms arising from benign prostatic hyperplasia. This case study aimed to assess their effectiveness as fiducial marker (FM) surrogates in prostate image-guided radiotherapy (IGRT). Method: Cone-beam CT images from a patient receiving prostate radiation therapy underwent manual alignment using UroLift implants and also prostate soft-tissue matching by five experienced therapeutic radiographers. The match values of both methods were compared using Bland–Altman analysis. All five observers were also asked to score the ease of matching using both approaches. Results: The 95% mean level of agreement for the UroLift matches were within a 2-mm threshold in all dimensions. Comparison of UroLift and prostate matches had 95% limit of agreement values of −0·98 to 1·78, −0·58 to 0·49 and −1·83 to 1·04 mm in the vertical, longitudinal and lateral planes, respectively. All of the UroLift matches were rated as ‘very easy’ or ‘possible with little difficulty’ by the five observers. Conclusion: A small difference between the CBCT UroLift and CBCT prostate match was found. It has been shown that IGRT to the prostate with the aid of the UroLift system implants and CBCT is feasible and can eliminate the need for FM implants. Wider evaluation in a large cohort is recommended.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49289875","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 : 2023-03-02DOI: 10.1017/S1460396922000413
M. Turna, R. Rzazade, Esra Küçükmorkoç, M. D. Canoğlu, Nadir Küçük, H. Çağlar
Abstract Introduction: Stereotactic radiosurgery (SRS) has become a preferred treatment in the initial management of brain metastases (BM). This study reported treatment outcomes and identified the patient, tumour, and treatment-related factors that predict failure, survival, and brain necrosis (BN). Methods: We retrospectively reviewed the electronic medical records of all BM patients treated with SRS. Patient, tumour characteristics and treatment details data were collected. All recurrences and BN were defined in the neurooncological tumour board. Results: From December 2016 to April 2020, 148 patients were analysed. The median follow-up was 14·8 months (range 6–51). At the time of analyses, 72·3% of the patients were alive. Presence of initial neurological deficit (HR; 2·71 (1·07–6·9); p = 0·036) and prior RT (HR; 2·55 (1·28–5·09); p = 0·008) is associated with worse overall survival. The local recurrence rate was 11·5 %. The distant brain metastasis rate was 53·4 %. Leptomeningeal metastasis was seen in 11 patients (7·4%). Symptomatic BN was seen in 19 patients (12·8 %). Bigger lesions (13 versus 23 mm diameter; p = 0·034) and cavity radiosurgery are associated with more BN (63·2 % versus 36·8%; p: 0·004). Conclusions: Distant BM is the leading cause of CNS recurrences and, salvage SRS is possible. Due to the increasing risk of developing BN routine metastasectomy should be made with caution.
{"title":"Stereotactic radiosurgery in brain metastasis: treatment outcomes and patterns of failure","authors":"M. Turna, R. Rzazade, Esra Küçükmorkoç, M. D. Canoğlu, Nadir Küçük, H. Çağlar","doi":"10.1017/S1460396922000413","DOIUrl":"https://doi.org/10.1017/S1460396922000413","url":null,"abstract":"Abstract Introduction: Stereotactic radiosurgery (SRS) has become a preferred treatment in the initial management of brain metastases (BM). This study reported treatment outcomes and identified the patient, tumour, and treatment-related factors that predict failure, survival, and brain necrosis (BN). Methods: We retrospectively reviewed the electronic medical records of all BM patients treated with SRS. Patient, tumour characteristics and treatment details data were collected. All recurrences and BN were defined in the neurooncological tumour board. Results: From December 2016 to April 2020, 148 patients were analysed. The median follow-up was 14·8 months (range 6–51). At the time of analyses, 72·3% of the patients were alive. Presence of initial neurological deficit (HR; 2·71 (1·07–6·9); p = 0·036) and prior RT (HR; 2·55 (1·28–5·09); p = 0·008) is associated with worse overall survival. The local recurrence rate was 11·5 %. The distant brain metastasis rate was 53·4 %. Leptomeningeal metastasis was seen in 11 patients (7·4%). Symptomatic BN was seen in 19 patients (12·8 %). Bigger lesions (13 versus 23 mm diameter; p = 0·034) and cavity radiosurgery are associated with more BN (63·2 % versus 36·8%; p: 0·004). Conclusions: Distant BM is the leading cause of CNS recurrences and, salvage SRS is possible. Due to the increasing risk of developing BN routine metastasectomy should be made with caution.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45274582","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 : 2023-02-28DOI: 10.1017/S1460396923000080
A. Fielding
Abstract Introduction: This is the second of two papers giving an overview of the use of Monte-Carlo techniques for radiotherapy applications. Methods: The first paper gave an introduction and introduced some of the codes that are available to the user wishing to model the different aspects of radiotherapy treatment. It also aims to serve as a useful companion to a curated collection of papers on Monte-Carlo that have been published in this journal. Results and Conclusions: This paper focuses on the application of Monte-Carlo to specific problems in radiotherapy. These include radiotherapy and imaging beam production, brachytherapy, phantom and patient dosimetry, detector modelling and track structure calculations for micro-dosimetry, nano-dosimetry and radiobiology.
{"title":"Monte-Carlo techniques for radiotherapy applications II: equipment and source modelling, dose calculations and radiobiology","authors":"A. Fielding","doi":"10.1017/S1460396923000080","DOIUrl":"https://doi.org/10.1017/S1460396923000080","url":null,"abstract":"Abstract Introduction: This is the second of two papers giving an overview of the use of Monte-Carlo techniques for radiotherapy applications. Methods: The first paper gave an introduction and introduced some of the codes that are available to the user wishing to model the different aspects of radiotherapy treatment. It also aims to serve as a useful companion to a curated collection of papers on Monte-Carlo that have been published in this journal. Results and Conclusions: This paper focuses on the application of Monte-Carlo to specific problems in radiotherapy. These include radiotherapy and imaging beam production, brachytherapy, phantom and patient dosimetry, detector modelling and track structure calculations for micro-dosimetry, nano-dosimetry and radiobiology.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43159774","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 : 2023-02-27DOI: 10.1017/S1460396923000079
A. Fielding
Abstract Introduction: The dose calculation plays a crucial role in many aspects of contemporary clinical radiotherapy treatment planning process. It therefore goes without saying that the accuracy of the dose calculation is of very high importance. The gold standard for absorbed dose calculation is the Monte-Carlo algorithm. Methods: This first of two papers gives an overview of the main openly available and supported codes that have been widely used for radiotherapy simulations. Results: The paper aims to provide an overview of Monte-Carlo in the field of radiotherapy and point the reader in the right direction of work that could help them get started or develop their existing understanding and use of Monte-Carlo algorithms in their practice. Conclusions: It also serves as a useful companion to a curated collection of papers on Monte-Carlo that have been published in this journal.
{"title":"Monte-Carlo techniques for radiotherapy applications I: introduction and overview of the different Monte-Carlo codes","authors":"A. Fielding","doi":"10.1017/S1460396923000079","DOIUrl":"https://doi.org/10.1017/S1460396923000079","url":null,"abstract":"Abstract Introduction: The dose calculation plays a crucial role in many aspects of contemporary clinical radiotherapy treatment planning process. It therefore goes without saying that the accuracy of the dose calculation is of very high importance. The gold standard for absorbed dose calculation is the Monte-Carlo algorithm. Methods: This first of two papers gives an overview of the main openly available and supported codes that have been widely used for radiotherapy simulations. Results: The paper aims to provide an overview of Monte-Carlo in the field of radiotherapy and point the reader in the right direction of work that could help them get started or develop their existing understanding and use of Monte-Carlo algorithms in their practice. Conclusions: It also serves as a useful companion to a curated collection of papers on Monte-Carlo that have been published in this journal.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42650278","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 : 2023-02-17DOI: 10.1017/S1460396923000018
R. Bailey
Abstract The first national UK proton beam therapy centre opened at The Christie NHS Foundation Trust in 2018, which alongside University College London Hospitals NHS Foundation Trust (UCLH) proton beam therapy centre, is expected to treat approximately seven-hundred and fifty patients per year at service ramp up. The aim of this editorial is to share with a wider audience the role of a Band 6 proton senior treatment radiographer working in a national NHS service and future developments of the service. Prior to the service being clinical, a range of processes were followed, including the creation of quality documents, departmental training and end-to-end testing, with the first patient receiving treatment in December 2018. Proton senior radiographers are responsible for the delivery of safe and accurate radiotherapy and ensuring a smooth patient pathway, through a multi-collaborative team approach. Although there are key differences between proton and photon radiotherapy, the fundamental aspects, including radiation principles, governance and patient advice are the same. The training package for proton senior radiographers includes an individual local induction as part of the proton education and competency framework, which incorporates practical learning, including clinical supervision and workshops, plus audio-visual presentations and workbooks to complete. Future developments of proton beam therapy include proton arc therapy and flash therapy, alongside educational developments, such as training the future workforce and advanced practice consultant radiographer roles. Shared learning through multi-collaboration of international proton beam therapy centres is crucial to improve care for future service users.
{"title":"Working in a UK national proton radiotherapy facility: the therapeutic radiographer perspective","authors":"R. Bailey","doi":"10.1017/S1460396923000018","DOIUrl":"https://doi.org/10.1017/S1460396923000018","url":null,"abstract":"Abstract The first national UK proton beam therapy centre opened at The Christie NHS Foundation Trust in 2018, which alongside University College London Hospitals NHS Foundation Trust (UCLH) proton beam therapy centre, is expected to treat approximately seven-hundred and fifty patients per year at service ramp up. The aim of this editorial is to share with a wider audience the role of a Band 6 proton senior treatment radiographer working in a national NHS service and future developments of the service. Prior to the service being clinical, a range of processes were followed, including the creation of quality documents, departmental training and end-to-end testing, with the first patient receiving treatment in December 2018. Proton senior radiographers are responsible for the delivery of safe and accurate radiotherapy and ensuring a smooth patient pathway, through a multi-collaborative team approach. Although there are key differences between proton and photon radiotherapy, the fundamental aspects, including radiation principles, governance and patient advice are the same. The training package for proton senior radiographers includes an individual local induction as part of the proton education and competency framework, which incorporates practical learning, including clinical supervision and workshops, plus audio-visual presentations and workbooks to complete. Future developments of proton beam therapy include proton arc therapy and flash therapy, alongside educational developments, such as training the future workforce and advanced practice consultant radiographer roles. Shared learning through multi-collaboration of international proton beam therapy centres is crucial to improve care for future service users.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44376969","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 : 2023-02-15DOI: 10.1017/S1460396923000031
Rogelio Manuel Diaz Moreno, M. Almada, Albin Ariel García Andino, C. Venencia
Abstract Introduction: In modulated radiotherapy treatments with the jaw tracking technique (JTT), the collimator jaws can dynamically follow the multileaf collimator apertures and reduce radiation leakage. This reduction protects normal tissue from unwanted doses. Previous research has highlighted the importance of defining which patients will benefit most from JTT. Besides, some authors have expressed their concerns about possible increases in monitor units (MUs). Treatments of patients with peripheral targets and isocentre located in the patient’s midline are of particular interest. The current work assessed the effect of JTT on these cases. Methods: JTT plans for thirty-two patients were compared to plans with the static jaws technique. The volumes of normal tissue receiving 5 Gy (V5), 10 Gy (V10) and 20 Gy (V20), mean dose (Dmean), target coverage parameters D95, D2% and Paddick’s conformity index (PCI) were compared. MUs were also registered for comparisons. The decrease in the jaws opening with JTT was correlated to the decrease in dose values in normal tissue. Results: Small decreases were observed in D95 and in D2% values, without statistical significance. A 5% average decrease in PCI values was noticed as well as significant decreases in V5, V10 and Dmean values, 9% on average. A 3% decrease in V20 was also observed. The number of MUs decreased by 2%. A significant correlation was found between the reduction of the secondary collimation opening areas and the dose delivered to normal tissue. Conclusions: JTT technique improved normal tissue protection in volumetric modulated arc therapy treatments for the patients included in the present study.
{"title":"Dosimetrical assessment of jaw tracking technique in volumetric modulated arc therapy for a sample of patients with lateralised targets","authors":"Rogelio Manuel Diaz Moreno, M. Almada, Albin Ariel García Andino, C. Venencia","doi":"10.1017/S1460396923000031","DOIUrl":"https://doi.org/10.1017/S1460396923000031","url":null,"abstract":"Abstract Introduction: In modulated radiotherapy treatments with the jaw tracking technique (JTT), the collimator jaws can dynamically follow the multileaf collimator apertures and reduce radiation leakage. This reduction protects normal tissue from unwanted doses. Previous research has highlighted the importance of defining which patients will benefit most from JTT. Besides, some authors have expressed their concerns about possible increases in monitor units (MUs). Treatments of patients with peripheral targets and isocentre located in the patient’s midline are of particular interest. The current work assessed the effect of JTT on these cases. Methods: JTT plans for thirty-two patients were compared to plans with the static jaws technique. The volumes of normal tissue receiving 5 Gy (V5), 10 Gy (V10) and 20 Gy (V20), mean dose (Dmean), target coverage parameters D95, D2% and Paddick’s conformity index (PCI) were compared. MUs were also registered for comparisons. The decrease in the jaws opening with JTT was correlated to the decrease in dose values in normal tissue. Results: Small decreases were observed in D95 and in D2% values, without statistical significance. A 5% average decrease in PCI values was noticed as well as significant decreases in V5, V10 and Dmean values, 9% on average. A 3% decrease in V20 was also observed. The number of MUs decreased by 2%. A significant correlation was found between the reduction of the secondary collimation opening areas and the dose delivered to normal tissue. Conclusions: JTT technique improved normal tissue protection in volumetric modulated arc therapy treatments for the patients included in the present study.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41771418","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 : 2023-02-15DOI: 10.1017/S1460396923000067
Ahmed Abdelmaqsoud, Natalia Vorotniak, D. Strauß, B. Hentschel
Abstract Introduction: This retrospective cohort study tries to determine if there is a correlation between the effectiveness of low-dose radiotherapy (LDRT) in treating painful inflammatory or degenerative musculoskeletal disorders (MSDs) and the applied radiotherapy energy. Patients and Methods: Between September 2019 and January 2020, a total of 91 patients with either painful inflammatory or degenerative MSDs were treated with LDRT. The inclusion criteria were patients older than 40 years with either painful inflammatory disorders such as epicondylitis humeri, plantar fasciitis or degenerative osteoarticular disorders of the wrist or ankle joints. All patients were treated with a single dose of 0·5 Gy and a total dose of 6·0 Gy (2 to 3 fractions weekly). Patients were divided into two groups. Orthovolt group was treated with 200 Kv, 15 mA and 1 mm copper filtration with different tubes according to the site to treatment using direct fields. The second group included patients treated with Linac machines with opposing fields using energies between 6 and 18 MV. The pain was evaluated before and on the last day of treatment and 4–6 months later using the Numerical Rating Scale. Results: 91 patients compatible with the inclusion criteria were identified with a median of 60 years. The median duration of symptoms was 6 months. 46% of patients were males, and 54% were females. The Orthovolt group included 49% of the patients and the Megavoltage group 51%. Most of the patients (98%) were previously treated with other methods such as local corticosteroid injection, painkillers or physiotherapy. At the end of the treatment, 60% of the patient’s showed subjective pain relief and only 6% had a complete response. The follow-up conducted 4 to 6 months after the treatment showed that 65% of patients had a complete response and 8% had an improvement. The comparison between both studied groups shows that the used energy does not affect the response either at the end of the treatment or at the second control. The relationship between the aetiology and the early and late responses shows no difference in the early response but a better late response in patients suffering from inflammatory diseases with a p-value of 0·015. The response according to the treated location shows that patients with osteoarthritis of the ankle joint have a worse response in comparison to other examined joints and plantar fasciitis. Conclusion: LDRT is an effective analgesic treatment option for both inflammatory and degenerative MSDs. There is no difference in response according to the used energy, and most of the patients show late responses 4 to 6 months after the treatment.
{"title":"The analgesic effect of low-dose radiotherapy in treating benign musculoskeletal painful disorders using different energies: A retrospective cohort study","authors":"Ahmed Abdelmaqsoud, Natalia Vorotniak, D. Strauß, B. Hentschel","doi":"10.1017/S1460396923000067","DOIUrl":"https://doi.org/10.1017/S1460396923000067","url":null,"abstract":"Abstract Introduction: This retrospective cohort study tries to determine if there is a correlation between the effectiveness of low-dose radiotherapy (LDRT) in treating painful inflammatory or degenerative musculoskeletal disorders (MSDs) and the applied radiotherapy energy. Patients and Methods: Between September 2019 and January 2020, a total of 91 patients with either painful inflammatory or degenerative MSDs were treated with LDRT. The inclusion criteria were patients older than 40 years with either painful inflammatory disorders such as epicondylitis humeri, plantar fasciitis or degenerative osteoarticular disorders of the wrist or ankle joints. All patients were treated with a single dose of 0·5 Gy and a total dose of 6·0 Gy (2 to 3 fractions weekly). Patients were divided into two groups. Orthovolt group was treated with 200 Kv, 15 mA and 1 mm copper filtration with different tubes according to the site to treatment using direct fields. The second group included patients treated with Linac machines with opposing fields using energies between 6 and 18 MV. The pain was evaluated before and on the last day of treatment and 4–6 months later using the Numerical Rating Scale. Results: 91 patients compatible with the inclusion criteria were identified with a median of 60 years. The median duration of symptoms was 6 months. 46% of patients were males, and 54% were females. The Orthovolt group included 49% of the patients and the Megavoltage group 51%. Most of the patients (98%) were previously treated with other methods such as local corticosteroid injection, painkillers or physiotherapy. At the end of the treatment, 60% of the patient’s showed subjective pain relief and only 6% had a complete response. The follow-up conducted 4 to 6 months after the treatment showed that 65% of patients had a complete response and 8% had an improvement. The comparison between both studied groups shows that the used energy does not affect the response either at the end of the treatment or at the second control. The relationship between the aetiology and the early and late responses shows no difference in the early response but a better late response in patients suffering from inflammatory diseases with a p-value of 0·015. The response according to the treated location shows that patients with osteoarthritis of the ankle joint have a worse response in comparison to other examined joints and plantar fasciitis. Conclusion: LDRT is an effective analgesic treatment option for both inflammatory and degenerative MSDs. There is no difference in response according to the used energy, and most of the patients show late responses 4 to 6 months after the treatment.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48434362","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 : 2023-02-14DOI: 10.1017/S1460396923000043
E. Weiss, A. Ricco, N. Mukhopadhyay, L. Rezai Gharai, Xiaoyan Deng, N. Jan, C. Guy
Abstract Purpose: In this study, the relation between radiation pneumonitis (RP) and a wide spectrum of clinical, radiographic and treatment-related factors was investigated. As scoring of low-grade RP can be subjective, RP grade ≥3 (RP ≥ G3) was chosen as a more objective and clinically significant endpoint for this study. Methods and Materials: 105 consecutive patients with locally advanced non-small cell lung cancer underwent conventionally fractionated radio-(chemo-)therapy to a median dose of 64 Gy. A retrospective analysis of 25 clinical (gender, race, pulmonary function, diabetes, statin use, smoking history), radiographic (emphysema, interstitial lung disease) and radiotherapy dose- and technique-related factors was performed to identify predictors of RP ≥ G3. Following testing of all variables for statistical association with RP using univariate analysis (UVA), a forward selection algorithm was implemented for building a multivariate predictive model (MVA) with limited sample size. Results: Median follow-up of surviving patients was 33 months (9–132 months). RP ≥ G3 was diagnosed in 10/105 (9·5%) patients. Median survival was 28·5 months. On UVA, predictors for RP ≥ G3 were diabetes, lower lobe location, planning target volume, volumetric modulated arc therapy (VMAT), lung V5 Gy (%), lung Vspared5 Gy (mL), lung V20 Gy (%) and heart V5 Gy (% and mL). On MVA, VMAT was the only significant predictor for RP ≥ G3 (p = 0·042). Lung V5 Gy and lung V20 Gy were borderline significant for RP ≥ G3. Patients with RP ≥ 3 had a median survival of 10 months compared to 29·5 months with RP < G3 (p = 0·02). Conclusions: In this study, VMAT was the only factor that was significantly correlated with RP ≥ G3. Avoiding RP ≥ G3 is important as a toxicity per se and as a risk factor for poor survival. To reduce RP, caution needs to be taken to reduce low-dose lung volumes in addition to other well-established dose constraints.
{"title":"Predictors of high-grade radiation pneumonitis following radiochemotherapy for locally advanced non-small cell lung cancer: analysis of clinical, radiographic and radiotherapy-related factors","authors":"E. Weiss, A. Ricco, N. Mukhopadhyay, L. Rezai Gharai, Xiaoyan Deng, N. Jan, C. Guy","doi":"10.1017/S1460396923000043","DOIUrl":"https://doi.org/10.1017/S1460396923000043","url":null,"abstract":"Abstract Purpose: In this study, the relation between radiation pneumonitis (RP) and a wide spectrum of clinical, radiographic and treatment-related factors was investigated. As scoring of low-grade RP can be subjective, RP grade ≥3 (RP ≥ G3) was chosen as a more objective and clinically significant endpoint for this study. Methods and Materials: 105 consecutive patients with locally advanced non-small cell lung cancer underwent conventionally fractionated radio-(chemo-)therapy to a median dose of 64 Gy. A retrospective analysis of 25 clinical (gender, race, pulmonary function, diabetes, statin use, smoking history), radiographic (emphysema, interstitial lung disease) and radiotherapy dose- and technique-related factors was performed to identify predictors of RP ≥ G3. Following testing of all variables for statistical association with RP using univariate analysis (UVA), a forward selection algorithm was implemented for building a multivariate predictive model (MVA) with limited sample size. Results: Median follow-up of surviving patients was 33 months (9–132 months). RP ≥ G3 was diagnosed in 10/105 (9·5%) patients. Median survival was 28·5 months. On UVA, predictors for RP ≥ G3 were diabetes, lower lobe location, planning target volume, volumetric modulated arc therapy (VMAT), lung V5 Gy (%), lung Vspared5 Gy (mL), lung V20 Gy (%) and heart V5 Gy (% and mL). On MVA, VMAT was the only significant predictor for RP ≥ G3 (p = 0·042). Lung V5 Gy and lung V20 Gy were borderline significant for RP ≥ G3. Patients with RP ≥ 3 had a median survival of 10 months compared to 29·5 months with RP < G3 (p = 0·02). Conclusions: In this study, VMAT was the only factor that was significantly correlated with RP ≥ G3. Avoiding RP ≥ G3 is important as a toxicity per se and as a risk factor for poor survival. To reduce RP, caution needs to be taken to reduce low-dose lung volumes in addition to other well-established dose constraints.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48146522","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 : 2023-01-19DOI: 10.1017/S1460396922000395
Q. Zhang, Y. Chen, D. Fang, C. Iannuzzi, E. Klein
Abstract Purpose: To assess the accuracy of the Varian PerfectPitch six-degree-of-freedom (6DOF) robotic couch by using a Varian SRS QA phantom. Methods: The stereotactic radiosurgery (SRS) phantom has five tungsten carbide BBs each with 7·5 mm in diameter arranged with the known geometry. Optical surface images and cone beam CT (CBCT) images of the phantom were taken at different pitch, roll and rotation angles. The pitch, roll, and rotation angles were varied from −3 to 3 degrees by inputs from the linac console. A total of 39 Vision RT images with different rotation angle combinations were collected, and the Vision RT software was used to determine the rotation angles and translational shifts from those images. Eight CBCT images at most allowed rotational angles were analysed by in-house software. The software took the coordinates of the voxel of the maximum CT number inside a 7·5-mm sphere surrounding one BB to be the measured position of this BB. Expected BB positions at different rotation angles were determined by multiplying measured BB positions at zero pitch and roll values by a rotation matrix. Applying the rotation matrix to 5 BB positions yielded 15 equations. A linear least square method was used for regression analysis to approximate the solutions of those equations. Results: Of the eight calculations from CBCT images, the maximum rotation angle differences (degree) were 0·10 for pitch, 0·15 for roll and 0·09 for yaw. The maximum translation differences were 0·3 mm in the left–right direction, 0·5 mm in the anterior–posterior direction and 0·4 mm in the superior–inferior direction. Conclusions: The uncertainties of the 6-DOF couch were examined with the methods of optical surface imaging and CBCT imaging of the SRS QA phantom. The rotational errors were less than 0·2 degree, and the isocentre shifts were less than 0·8 mm.
{"title":"Evaluation of the accuracy of a six-degree-of-freedom robotic couch using optical surface and cone beam CT images of an SRS QA phantom","authors":"Q. Zhang, Y. Chen, D. Fang, C. Iannuzzi, E. Klein","doi":"10.1017/S1460396922000395","DOIUrl":"https://doi.org/10.1017/S1460396922000395","url":null,"abstract":"Abstract Purpose: To assess the accuracy of the Varian PerfectPitch six-degree-of-freedom (6DOF) robotic couch by using a Varian SRS QA phantom. Methods: The stereotactic radiosurgery (SRS) phantom has five tungsten carbide BBs each with 7·5 mm in diameter arranged with the known geometry. Optical surface images and cone beam CT (CBCT) images of the phantom were taken at different pitch, roll and rotation angles. The pitch, roll, and rotation angles were varied from −3 to 3 degrees by inputs from the linac console. A total of 39 Vision RT images with different rotation angle combinations were collected, and the Vision RT software was used to determine the rotation angles and translational shifts from those images. Eight CBCT images at most allowed rotational angles were analysed by in-house software. The software took the coordinates of the voxel of the maximum CT number inside a 7·5-mm sphere surrounding one BB to be the measured position of this BB. Expected BB positions at different rotation angles were determined by multiplying measured BB positions at zero pitch and roll values by a rotation matrix. Applying the rotation matrix to 5 BB positions yielded 15 equations. A linear least square method was used for regression analysis to approximate the solutions of those equations. Results: Of the eight calculations from CBCT images, the maximum rotation angle differences (degree) were 0·10 for pitch, 0·15 for roll and 0·09 for yaw. The maximum translation differences were 0·3 mm in the left–right direction, 0·5 mm in the anterior–posterior direction and 0·4 mm in the superior–inferior direction. Conclusions: The uncertainties of the 6-DOF couch were examined with the methods of optical surface imaging and CBCT imaging of the SRS QA phantom. The rotational errors were less than 0·2 degree, and the isocentre shifts were less than 0·8 mm.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43400294","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 : 2023-01-16DOI: 10.1017/S1460396922000450
Arisara Chirawattana, I. Chitapanarux, W. Nobnop
Abstract Purpose: To limit the entrance dose to normal tissue and achieve the appropriate treatment time (TT) by using three different virtual structures with directional blocks for left-sided post-mastectomy radiation therapy (PMRT) with regional nodal irradiation (RNI). Methods and materials: Ten breast cancer patients who received PMRT by helical tomotherapy were enrolled. Three virtual structures were created for each patient: Organ-based, L-shaped (LB) and C-shaped (CB). The dose to the target and organ at risk (OARs), TT, the volume which received dose 5 Gy (V5Gy), integral dose (ID) and block structure contouring workload (BSCW) of the three virtual block techniques were evaluated. The performance scores were used to explore the suitable technique. Results: The CB plans showed a significantly better V5Gy, ID and contralateral breast-sparing. However, the CB plans revealed the longest TT and BSCW (p < 0·001). Contrary to the LB, the LB plans showed a significantly reduced TT and BSCW and provided the balance of plan efficiency with the highest score. Conclusion: The LB technique is considered to be the suitable technique for left-sided PMRT with RNI and provided the advantage of TT, V5Gy, ID and BSCW while maintaining acceptable criteria for the target and OARs.
{"title":"Improvement of helical tomotherapy treatment plan efficiency with block techniques for left-sided post-mastectomy radiation therapy","authors":"Arisara Chirawattana, I. Chitapanarux, W. Nobnop","doi":"10.1017/S1460396922000450","DOIUrl":"https://doi.org/10.1017/S1460396922000450","url":null,"abstract":"Abstract Purpose: To limit the entrance dose to normal tissue and achieve the appropriate treatment time (TT) by using three different virtual structures with directional blocks for left-sided post-mastectomy radiation therapy (PMRT) with regional nodal irradiation (RNI). Methods and materials: Ten breast cancer patients who received PMRT by helical tomotherapy were enrolled. Three virtual structures were created for each patient: Organ-based, L-shaped (LB) and C-shaped (CB). The dose to the target and organ at risk (OARs), TT, the volume which received dose 5 Gy (V5Gy), integral dose (ID) and block structure contouring workload (BSCW) of the three virtual block techniques were evaluated. The performance scores were used to explore the suitable technique. Results: The CB plans showed a significantly better V5Gy, ID and contralateral breast-sparing. However, the CB plans revealed the longest TT and BSCW (p < 0·001). Contrary to the LB, the LB plans showed a significantly reduced TT and BSCW and provided the balance of plan efficiency with the highest score. Conclusion: The LB technique is considered to be the suitable technique for left-sided PMRT with RNI and provided the advantage of TT, V5Gy, ID and BSCW while maintaining acceptable criteria for the target and OARs.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41703779","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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