Pub Date : 2024-06-04DOI: 10.1016/j.adro.2024.101548
Purpose
Glioblastoma (GBM) recurrence poses challenges in radiation therapy treatment planning because reirradiation has limited leeway needed for precise target delineation. Although effective radiotracers are emerging for treatment planning, comparisons of 11C-methionine positron emission tomography (MET-PET), 68Ga-prostate-specific membrane antigen PET (PSMA-PET), and magnetic resonance imaging (MRI) for contouring recurrent GBMs are lacking in the literature. This case study aimed to highlight the differences and similarities in target contours delineated from 3 examinations, aiming to raise doubts about the adequacy of current radiation therapy planning practices.
Methods and Materials
A 37-year-old female patient with recurrent Isocitrate dehydrogenase (IDH)1/2 wild-type GBM underwent MRI, MET-PET, and PSMA-PET scans. Target delineations were performed, and volumes were compared using the Dice similarity coefficient, conformity index, and overlap volume, considering different planning target volume margins.
Results
We found that MET-PET and MRI volumes showed superior agreement compared with PSMA-PET across all similarity parameters, indicating a more marked discrepancy between PSMA-PET and other modalities. Increasing planning target volume margins demonstrated progressive convergence in intervolume discrepancies. Notably, PSMA-PET delineated larger volumes extending beyond MRI-based volumes.
Conclusions
MRI alone may not suffice for target delineation in recurrent GBMs. PET imaging modalities offer complementary insights. Combined PET-MRI guidance could improve tumor boundary detection in target delineation for reirradiation. Prospective trials are necessary to ascertain its impact on patient outcomes.
{"title":"Comparative Analysis of Recurrent Glioblastoma Target Contours via 11C-Methionine, 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography, and Magnetic Resonance Imaging: Implications for Precision Radiotherapy Planning","authors":"","doi":"10.1016/j.adro.2024.101548","DOIUrl":"10.1016/j.adro.2024.101548","url":null,"abstract":"<div><h3>Purpose</h3><p>Glioblastoma (GBM) recurrence poses challenges in radiation therapy treatment planning because reirradiation has limited leeway needed for precise target delineation. Although effective radiotracers are emerging for treatment planning, comparisons of <sup>11</sup>C-methionine positron emission tomography (MET-PET), <sup>68</sup>Ga-prostate-specific membrane antigen PET (PSMA-PET), and magnetic resonance imaging (MRI) for contouring recurrent GBMs are lacking in the literature. This case study aimed to highlight the differences and similarities in target contours delineated from 3 examinations, aiming to raise doubts about the adequacy of current radiation therapy planning practices.</p></div><div><h3>Methods and Materials</h3><p>A 37-year-old female patient with recurrent Isocitrate dehydrogenase (IDH)1/2 wild-type GBM underwent MRI, MET-PET, and PSMA-PET scans. Target delineations were performed, and volumes were compared using the Dice similarity coefficient, conformity index, and overlap volume, considering different planning target volume margins.</p></div><div><h3>Results</h3><p>We found that MET-PET and MRI volumes showed superior agreement compared with PSMA-PET across all similarity parameters, indicating a more marked discrepancy between PSMA-PET and other modalities. Increasing planning target volume margins demonstrated progressive convergence in intervolume discrepancies. Notably, PSMA-PET delineated larger volumes extending beyond MRI-based volumes.</p></div><div><h3>Conclusions</h3><p>MRI alone may not suffice for target delineation in recurrent GBMs. PET imaging modalities offer complementary insights. Combined PET-MRI guidance could improve tumor boundary detection in target delineation for reirradiation. Prospective trials are necessary to ascertain its impact on patient outcomes.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101548"},"PeriodicalIF":2.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001118/pdfft?md5=ddbb8f70ebb7616e5acf4ccd15fdc898&pid=1-s2.0-S2452109424001118-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-03DOI: 10.1016/j.adro.2024.101546
Dylan J. Cooper MD , Jacob Eckstein MD , Baho Sidiqi MD, MPH , Zaker H. Rana MD , Ariana Matarangas BA , Ashna Shah BA , Nefia Chacko BA , Joseph Mancuso BS , Travis Minutoli BS , Alana Zinkin BS , Kirti Sharma BS , Ria Mehta BA , Louis Potters MD , Bhupesh Parashar MD, DrPH
Purpose
Cancer diagnosis and treatment, including radiation therapy (RT), cause significant patient stress. Mindfulness and social support have been shown to help manage the psychological effects of cancer treatment. The objective of our study was to determine the sociodemographic and clinical factors associated with stress burden in patients receiving RT.
Methods and Materials
Patients receiving RT for cancer at a single institution were given a 3-section survey to complete during the first on-treatment visit. The survey included the Perceived Stress Scale, Medical Outcomes Study Social Support Survey, and Mindfulness Attention Awareness Scale, which were used to measure stress, social support, and trait mindfulness, respectively. Linear regression analysis was performed to determine associations between perceived stress and age, patient sex, race and ethnicity, treatment intent, disease site, trait mindfulness, and social support. Factors significant in univariable analysis were analyzed with a multivariable analysis.
Results
A total of 93 patients undergoing RT at a tertiary care academic institution were recruited from July to September 2019. Median scores for Perceived Stress Scale, Medical Outcomes Study Social Support Survey, and Mindfulness Attention Awareness Scale were 14.6 (range, 0-31; SD, 6.9), 4.2 (range, 1-5; SD, 1.0), and 5.1 (range, 3.1-6.0; SD, 0.8), respectively. On univariable analysis, mindfulness and social support were associated with decreased stress burden, and female sex and palliative intent were associated with increased stress burden. These factors all maintained significance in multivariable analysis.
Conclusions
These results suggest measures to improve mindfulness and perceived social support, such as mindfulness meditation and psychoeducational approaches, may lessen the stress burden and improve quality of life for patients undergoing RT. Future studies should analyze the longitudinal impact of individual patient characteristics, including patient sex and treatment intent, to better understand their effects on psychological maladjustment during cancer care.
{"title":"Trait Mindfulness and Social Support Predict Lower Perceived Stress Burden in Patients Undergoing Radiation Therapy","authors":"Dylan J. Cooper MD , Jacob Eckstein MD , Baho Sidiqi MD, MPH , Zaker H. Rana MD , Ariana Matarangas BA , Ashna Shah BA , Nefia Chacko BA , Joseph Mancuso BS , Travis Minutoli BS , Alana Zinkin BS , Kirti Sharma BS , Ria Mehta BA , Louis Potters MD , Bhupesh Parashar MD, DrPH","doi":"10.1016/j.adro.2024.101546","DOIUrl":"10.1016/j.adro.2024.101546","url":null,"abstract":"<div><h3>Purpose</h3><p>Cancer diagnosis and treatment, including radiation therapy (RT), cause significant patient stress. Mindfulness and social support have been shown to help manage the psychological effects of cancer treatment. The objective of our study was to determine the sociodemographic and clinical factors associated with stress burden in patients receiving RT.</p></div><div><h3>Methods and Materials</h3><p>Patients receiving RT for cancer at a single institution were given a 3-section survey to complete during the first on-treatment visit. The survey included the Perceived Stress Scale, Medical Outcomes Study Social Support Survey, and Mindfulness Attention Awareness Scale, which were used to measure stress, social support, and trait mindfulness, respectively. Linear regression analysis was performed to determine associations between perceived stress and age, patient sex, race and ethnicity, treatment intent, disease site, trait mindfulness, and social support. Factors significant in univariable analysis were analyzed with a multivariable analysis.</p></div><div><h3>Results</h3><p>A total of 93 patients undergoing RT at a tertiary care academic institution were recruited from July to September 2019. Median scores for Perceived Stress Scale, Medical Outcomes Study Social Support Survey, and Mindfulness Attention Awareness Scale were 14.6 (range, 0-31; SD, 6.9), 4.2 (range, 1-5; SD, 1.0), and 5.1 (range, 3.1-6.0; SD, 0.8), respectively. On univariable analysis, mindfulness and social support were associated with decreased stress burden, and female sex and palliative intent were associated with increased stress burden. These factors all maintained significance in multivariable analysis.</p></div><div><h3>Conclusions</h3><p>These results suggest measures to improve mindfulness and perceived social support, such as mindfulness meditation and psychoeducational approaches, may lessen the stress burden and improve quality of life for patients undergoing RT. Future studies should analyze the longitudinal impact of individual patient characteristics, including patient sex and treatment intent, to better understand their effects on psychological maladjustment during cancer care.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101546"},"PeriodicalIF":2.2,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S245210942400109X/pdfft?md5=05fbbd8d56a98aeac6df53d283024bb6&pid=1-s2.0-S245210942400109X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141275903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.adro.2024.101536
{"title":"Erratum to: Crooks J, Dominic O, Shephard M, et al. Cost of Treatment for Brain Metastases Using Data From a National Health Insurance Provider. Adv Radiat Oncol. 2024;9:101438.","authors":"","doi":"10.1016/j.adro.2024.101536","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101536","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 6","pages":"Article 101536"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S245210942400099X/pdfft?md5=380e1a9af751ae00732461498e7c26ae&pid=1-s2.0-S245210942400099X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-27DOI: 10.1016/j.adro.2024.101544
Samuel Hellman PhD , Laszlo Voros MS , Victoria Y. Yu PhD , Dale M. Lovelock PhD , Sean Berry PhD , Lei Zhang PhD , Margie Hunt MS , Joseph O. Deasy PhD , Laura Cervino PhD
Purpose
In radiation therapy (RT), if an immobilization device is lost or damaged, the patient may need to be brought back for resimulation, device fabrication, and treatment planning, causing additional imaging radiation exposure, inconvenience, cost, and delay. We describe a simulation-free method for replacing lost or damaged RT immobilization devices.
Methods and Materials
Replacement immobilization devices were fabricated using existing simulation scans as design templates by computer numerical control (CNC) milling of molds made from extruded polystyrene (XPS). XPS material attenuation and bolusing properties were evaluated, a standard workflow was established, and 12 patients were treated. Setup reproducibility was analyzed postfacto using Dice similarity coefficient (DSC) and mean distance to agreement (MDA) calculations comparing onboard treatment imaging with computed tomography (CT) simulations.
Results
Results showed that XPS foam material had less dosimetric impact (attenuation and bolusing) than materials used for our standard immobilization devices. The average direct cost to produce each replacement mold was $242.17, compared with over $2000 for standard resimulation. Hands-on time to manufacture was 86.3 minutes, whereas molds were delivered in as little as 4 hours and mostly within 24 hours, compared with a week or more required for standard resimulation. Each mold was optically scanned after production and was measured to be within 2-mm tolerance (pointwise displacement) of design input. All patients were successfully treated using the CNC-milled foam mold replacements, and pretreatment imaging verified satisfactory clinical setup reproduction for each case. The external body contours from the setup cone beam CT and the original CT simulation with matching superior-inferior extent were compared by calculating the DSC and MDA. DSC average was 0.966 (SD, 0.011), and MDA average was 2.694 mm (SD, 0.986).
Conclusions
CNC milling of XPS foam is a quicker and more convenient solution than traditional resimulation for replacing lost or damaged RT immobilization devices. Satisfactory patient immobilization, low dosimetric impact compared with standard immobilization devices, and strong correlation of onboard contours with CT simulations are shown. We share our clinical experience, workflow, and manufacturing guide to help other clinicians who may want to adopt this solution.
{"title":"A Simulation-Free Replacement Solution for Radiation Therapy Immobilization Devices Using Computer Numerical Control (CNC) -Milled Polystyrene Molds","authors":"Samuel Hellman PhD , Laszlo Voros MS , Victoria Y. Yu PhD , Dale M. Lovelock PhD , Sean Berry PhD , Lei Zhang PhD , Margie Hunt MS , Joseph O. Deasy PhD , Laura Cervino PhD","doi":"10.1016/j.adro.2024.101544","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101544","url":null,"abstract":"<div><h3>Purpose</h3><p>In radiation therapy (RT), if an immobilization device is lost or damaged, the patient may need to be brought back for resimulation, device fabrication, and treatment planning, causing additional imaging radiation exposure, inconvenience, cost, and delay. We describe a simulation-free method for replacing lost or damaged RT immobilization devices.</p></div><div><h3>Methods and Materials</h3><p>Replacement immobilization devices were fabricated using existing simulation scans as design templates by computer numerical control (CNC) milling of molds made from extruded polystyrene (XPS). XPS material attenuation and bolusing properties were evaluated, a standard workflow was established, and 12 patients were treated. Setup reproducibility was analyzed postfacto using Dice similarity coefficient (DSC) and mean distance to agreement (MDA) calculations comparing onboard treatment imaging with computed tomography (CT) simulations.</p></div><div><h3>Results</h3><p>Results showed that XPS foam material had less dosimetric impact (attenuation and bolusing) than materials used for our standard immobilization devices. The average direct cost to produce each replacement mold was $242.17, compared with over $2000 for standard resimulation. Hands-on time to manufacture was 86.3 minutes, whereas molds were delivered in as little as 4 hours and mostly within 24 hours, compared with a week or more required for standard resimulation. Each mold was optically scanned after production and was measured to be within 2-mm tolerance (pointwise displacement) of design input. All patients were successfully treated using the CNC-milled foam mold replacements, and pretreatment imaging verified satisfactory clinical setup reproduction for each case. The external body contours from the setup cone beam CT and the original CT simulation with matching superior-inferior extent were compared by calculating the DSC and MDA. DSC average was 0.966 (SD, 0.011), and MDA average was 2.694 mm (SD, 0.986).</p></div><div><h3>Conclusions</h3><p>CNC milling of XPS foam is a quicker and more convenient solution than traditional resimulation for replacing lost or damaged RT immobilization devices. Satisfactory patient immobilization, low dosimetric impact compared with standard immobilization devices, and strong correlation of onboard contours with CT simulations are shown. We share our clinical experience, workflow, and manufacturing guide to help other clinicians who may want to adopt this solution.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101544"},"PeriodicalIF":2.2,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001076/pdfft?md5=65a237c1b6cd6e04708b4dc805634c32&pid=1-s2.0-S2452109424001076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-08DOI: 10.1016/j.adro.2024.101538
Purpose
Multiple brain metastases can be treated efficiently with stereotactic radiosurgery (SRS) using a single-isocenter dynamic conformal arc (SIDCA) technique. Currently, plans are manually optimized, which may lead to unnecessary table angles and arcs being used. This study aimed to evaluate an automatic 4π optimization SIDCA algorithm for treatment efficiency and plan quality.
Methods and Materials
Automatic 4π-optimized SIDCA plans were created and compared with the manually optimized clinical plans for 54 patients who underwent single-fraction SRS for 2 to 10 metastases. The number of table angles and number of arcs were compared with a paired t test using a Bonferroni-corrected significance level of P < .05/4 = .0125. The reduction in treatment time was estimated from the difference in the number of table angles and arcs. Plan quality was assessed through the volume-averaged inverse Paddick Conformity Index (CI) and Gradient Index (GI) and the volume of normal brain surrounding each metastasis receiving 12 Gy (local V12 Gy). For a 5-patient subset, the automatic plans were manually adjusted further. CI and GI were assessed for noninferiority using a 1-sided t test with the noninferiority limit equal to the 95% interobserver reproducibility limit from a separate planning study (corrected significance level P < .05/[4 − 1] = .017).
Results
The automatic plans significantly improved treatment efficiency with a mean reduction in the number of table angles and arcs of −0.5 ± 0.1 and −1.3 ± 0.2, respectively (±SE; both P < .001). Estimated treatment time saving was −2.7 ± 0.5 minutes, 14% of the total treatment time. The volume-averaged CI and GI were noninferior to the clinical plans (both P < .001), although there was a small systematic shift in CI of 0.07 ± 0.01. The resulting difference in local V12 Gy, 0.25 ± 0.04 cm3, was not clinically significant. Minor manual adjustment of the automatic plans removed these slight differences while preserving the improved treatment efficiency.
Conclusions
Automatic 4π optimization can generate SIDCA SRS plans with improved treatment efficiency and noninferior plan quality.
目的使用单等中心动态适形弧线（SIDCA）技术进行立体定向放射手术（SRS）可有效治疗多发性脑转移瘤。目前，计划需要手动优化，这可能会导致不必要的工作台角度和弧度的使用。本研究旨在评估自动4π优化SIDCA算法的治疗效率和计划质量。方法和材料为54名接受单分次SRS治疗2至10个转移灶的患者创建了自动4π优化SIDCA计划，并将其与人工优化的临床计划进行了比较。台角数和弧线数的比较采用配对 t 检验，Bonferroni 校正显著性水平为 P < .05/4 = .0125。根据工作台角度和弧度数量的差异估算出治疗时间的缩短。计划质量通过体积均值的反Paddick一致性指数（CI）和梯度指数（GI）以及每个转移灶周围接受12 Gy治疗的正常脑体积（局部V12 Gy）进行评估。对于 5 名患者的子集，还需进一步手动调整自动计划。采用单侧 t 检验评估 CI 和 GI 的非劣效性，非劣效性限值等于另一项计划研究中 95% 的观察者间可重复性限值（校正显著性水平 P < .05/[4 - 1] = .017）。结果自动计划显著提高了治疗效率，工作台角度和弧度的平均减少量分别为 -0.5 ± 0.1 和 -1.3 ± 0.2（±SE；均为 P < .001）。估计节省的治疗时间为 -2.7 ± 0.5 分钟，占总治疗时间的 14%。容积平均 CI 和 GI 均不劣于临床计划（均为 P <.001），但 CI 有 0.07 ± 0.01 的微小系统性偏移。由此产生的局部 V12 Gy 差异（0.25 ± 0.04 cm3）并无临床意义。结论自动 4π 优化可以生成 SIDCA SRS 计划，并提高治疗效率和计划质量。
{"title":"Improving the Efficiency of Single-Isocenter Multiple Metastases Stereotactic Radiosurgery Treatment","authors":"","doi":"10.1016/j.adro.2024.101538","DOIUrl":"10.1016/j.adro.2024.101538","url":null,"abstract":"<div><h3>Purpose</h3><p>Multiple brain metastases can be treated efficiently with stereotactic radiosurgery (SRS) using a single-isocenter dynamic conformal arc (SIDCA) technique. Currently, plans are manually optimized, which may lead to unnecessary table angles and arcs being used. This study aimed to evaluate an automatic 4π optimization SIDCA algorithm for treatment efficiency and plan quality.</p></div><div><h3>Methods and Materials</h3><p>Automatic 4π-optimized SIDCA plans were created and compared with the manually optimized clinical plans for 54 patients who underwent single-fraction SRS for 2 to 10 metastases. The number of table angles and number of arcs were compared with a paired <em>t</em> test using a Bonferroni-corrected significance level of <em>P</em> < .05/4 = .0125. The reduction in treatment time was estimated from the difference in the number of table angles and arcs. Plan quality was assessed through the volume-averaged inverse Paddick Conformity Index (CI) and Gradient Index (GI) and the volume of normal brain surrounding each metastasis receiving 12 Gy (local V12 Gy). For a 5-patient subset, the automatic plans were manually adjusted further. CI and GI were assessed for noninferiority using a 1-sided <em>t</em> test with the noninferiority limit equal to the 95% interobserver reproducibility limit from a separate planning study (corrected significance level <em>P</em> < .05/[4 − 1] = .017).</p></div><div><h3>Results</h3><p>The automatic plans significantly improved treatment efficiency with a mean reduction in the number of table angles and arcs of −0.5 ± 0.1 and −1.3 ± 0.2, respectively (±SE; both <em>P</em> < .001). Estimated treatment time saving was −2.7 ± 0.5 minutes, 14% of the total treatment time. The volume-averaged CI and GI were noninferior to the clinical plans (both <em>P</em> < .001), although there was a small systematic shift in CI of 0.07 ± 0.01. The resulting difference in local V12 Gy, 0.25 ± 0.04 cm<sup>3</sup>, was not clinically significant. Minor manual adjustment of the automatic plans removed these slight differences while preserving the improved treatment efficiency.</p></div><div><h3>Conclusions</h3><p>Automatic 4π optimization can generate SIDCA SRS plans with improved treatment efficiency and noninferior plan quality.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101538"},"PeriodicalIF":2.2,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001015/pdfft?md5=c449d0955a3ad9aec0796c1335bb36f4&pid=1-s2.0-S2452109424001015-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141027708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Practical guidelines and tips for effective and robust radiation therapy treatment planning for patients with breast cancer are addressed for fixed-field intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) techniques. The concepts described here are general and valid on all treatment planning systems. However, some details shown here have been applied to the Varian platforms used at the authors’ institutions.
Methods and Materials
The specific aspects of using C-arm– or O-ring–mounted linear accelerators are covered in the document, as well as tips for dealing with certain resource constraints, target cropping, and skin flash aiming to reduce risks of skin toxicity and to manage (residual after breath control) respiration motion or edema.
Results
A decision tree is presented, and practical solutions for cases where a target volume is contoured or not and where volumetric modulated arc therapy or fixed-beam intensity modulation should be applied and details about the technical implementation (tangential IMRT, butterfly IMRT or VMAT, and large partial VMAT arcs) are discussed. Target cropping and skin flash implications are discussed in detail, and links to plan robustness are outlined.
Conclusions
Practical guidelines for breast planning are presented and summarized with a decision tree and technical summaries.
目的 针对固定场调强放射治疗（IMRT）或容积调强弧形治疗（VMAT）技术，为乳腺癌患者制定有效、稳健的放射治疗计划提供实用指南和技巧。这里描述的概念是通用的，适用于所有治疗计划系统。方法和材料本文介绍了使用 C 型臂或 O 型环安装直线加速器的具体方面，以及处理某些资源限制、靶裁剪和皮肤闪光的技巧，目的是降低皮肤中毒风险和控制（呼吸控制后残留的）呼吸运动或水肿。结果 提出了一个决策树，讨论了靶区是否轮廓分明、应用容积调制弧治疗或固定光束强度调制的实际解决方案，以及技术实施的细节（切向 IMRT、蝶形 IMRT 或 VMAT，以及大型部分 VMAT 弧）。详细讨论了靶区裁剪和皮肤闪光的影响，并概述了与计划稳健性的联系。结论本文介绍了乳腺计划的实用指南，并通过决策树和技术摘要进行了总结。
{"title":"Intensity Modulated Therapy for Patients With Breast Cancer. Practical Guidelines and Tips for an Effective Treatment Planning Strategy","authors":"Antonella Fogliata MSc , Hester Burger MSc , Annemari Groenewald PhD , Lydia Punt MD , Jeannette Parkes MD , Luca Cozzi PhD","doi":"10.1016/j.adro.2024.101535","DOIUrl":"10.1016/j.adro.2024.101535","url":null,"abstract":"<div><h3>Purpose</h3><p>Practical guidelines and tips for effective and robust radiation therapy treatment planning for patients with breast cancer are addressed for fixed-field intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) techniques. The concepts described here are general and valid on all treatment planning systems. However, some details shown here have been applied to the Varian platforms used at the authors’ institutions.</p></div><div><h3>Methods and Materials</h3><p>The specific aspects of using C-arm– or O-ring–mounted linear accelerators are covered in the document, as well as tips for dealing with certain resource constraints, target cropping, and skin flash aiming to reduce risks of skin toxicity and to manage (residual after breath control) respiration motion or edema.</p></div><div><h3>Results</h3><p>A decision tree is presented, and practical solutions for cases where a target volume is contoured or not and where volumetric modulated arc therapy or fixed-beam intensity modulation should be applied and details about the technical implementation (tangential IMRT, butterfly IMRT or VMAT, and large partial VMAT arcs) are discussed. Target cropping and skin flash implications are discussed in detail, and links to plan robustness are outlined.</p></div><div><h3>Conclusions</h3><p>Practical guidelines for breast planning are presented and summarized with a decision tree and technical summaries.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101535"},"PeriodicalIF":2.3,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000988/pdfft?md5=48a61e92eaea3b397b1f1e3a22f705a3&pid=1-s2.0-S2452109424000988-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-04DOI: 10.1016/j.adro.2024.101537
Jasmijn M. Westerhoff MD , Pim T.S. Borman PhD , Reijer H.A. Rutgers BSc , Bas W. Raaymakers PhD , Neil Winchester MSc , Helena M. Verkooijen PhD , Martin F. Fast PhD
Purpose
To assess patient experience and anxiety during magnetic resonance (MR)–guided radiation therapy (MRgRT) using a hybrid 1.5Tesla (T) MR-guided linear accelerator (MR-Linac) when offered calming video content.
Methods and Materials
A single-center study was conducted within the Multi-Outcome Evaluation of Radiation Therapy Using the MR-Linac (MOMENTUM) cohort. Patients were offered to watch calming video content on a video monitor during treatment. Questionnaires were used to assess patient experience (MR-Linac patient-reported experience) and anxiety (State-Trait Anxiety Inventory, STAI) at first treatment fraction (M1) and at third, fourth, or fifth treatment fraction (M2). Paired t tests were used to test for significant differences, and effect sizes (ESs) were used to estimate the magnitude of the difference.
Results
Between November 2021 and November 2022, 66 patients were included. The majority were men (n = 59, 89%). MRgRT was most frequently delivered to prostate cancer (n = 45, 68%) followed by a lesion in the pancreas (n = 8, 12%). At M1 and M2, 24 of 59 patients (41%) preferred to watch calming video content. One patient was not able to look at the video monitor comfortably at M1. Patient experience was generally favorable or neutral; tingling sensations were reported by 17% of patients. Anxiety levels were high (16%), moderate (18%), or low to none (67%) prior to M1. STAI scores were 33 (SD, 9) prior to M1 and 29 (SD, 7) after M1 (ES, 0.7; P < .001). STAI scores were 32 (SD, 9) prior to M2 and 31 (SD, 8) after M2 (ES, 0.4; P = .009).
Conclusions
Patients were able to comfortably view the video monitor during MRgRT. Consequently, this setup could be used for future applications, such as biofeedback. A sizable minority of patients preferred to watch calming videos that distracted them during treatment. Although the patients’ experience was overall excellent, anxiety was reported. Anxiety levels were highest prior to treatment and decreased after treatment.
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