Adaptive Radiotherapy for Invasive Bladder Cancer, a Feasibility Study

Pos, Floris J.; Hulshof, M.C.C.M.; Lebesque, Joos V.; Lotz, Heidi; Tienhoven, Geertjan van; Moonen, L.; Remeijer, P.

doi:10.1016/j.ijrobp.2005.07.527

Cited by 34 publications

(61 citation statements)

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“…This presents promising outcomes for the use of Lipiodol for boost and partial bladder treatment delivery. Online adaptive radiotherapy acts in the interest of varying bladder sizes between fractions and has been deemed a viable method of treatment delivery in many studies [21,[27][28][29][30]. Lipiodol and fiducial markers can both work well with adaptive planning, by providing enhanced visualization of the target as well as improved registration, which are fundamental to a successful online adaptive protocol.…”

Section: Discussionmentioning

confidence: 99%

A review of the use of fiducial markers for image-guided bladder radiotherapy

Nolan

Forde

2015

Acta Oncologica

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Background: Enhancing target visualization and reducing set-up errors in image-guided radiotherapy (IGRT) are issues faced when trying to implement more conformal and partial bladder techniques. This review examines the evidence available pertaining to the clinical use of Lipiodol and gold fiducials for IGRT for bladder cancer. Material and methods: Nine published articles relating to the feasibility of using Lipiodol injections or gold fiducial markers in IGRT for bladder patients were recruited from a database search strategy. Set-up errors were evaluated in addition to the stability and visibility of each on verification imaging. Adverse reactions from the insertion of each method were also assessed. Results: Both Lipiodol and gold fiducials have the potential to remain stable and visible in the bladder, however, fading, washout and seed loss was also reported. Set-up errors can be reduced by using Lipiodol or fiducial registration when compared to other registration techniques. Adverse reactions reported were minimal for each. Conclusion: Current evidence suggests that Lipiodol injections and gold fiducial markers present as promising and highly accurate methods of overcoming interfraction bladder motion in IGRT.

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Section: Discussionmentioning

confidence: 99%

A review of the use of fiducial markers for image-guided bladder radiotherapy

Nolan

Forde

2015

Acta Oncologica

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“…Even without any correction, the anisotropic optimisation on individual CTVs reduces the volume of normal tissue within the high dose region by half. Previous studies have only investigated or implemented adaptation of the PTV based on multiple CT scans [5,6,11]. This study shows, as Burridge et al [5] indicated, that individual daily adaptation of the PTV is superior to adaptation to a series of repeat scans.…”

Section: Discussionmentioning

confidence: 71%

“…However, an interchange of 1Á2 mm in two of the margins has only a small impact on the resulting volume of normal tissue enclosed by the PTV. With this in mind, it would be possible to reduce the number of iterations to where a 'good Table III [6]. It should also be mentioned that the simulation of various tumour locations includes uncertainties.…”

Section: Discussionmentioning

confidence: 99%

“…To improve treatment accuracy and ultimately enable tumour dose escalation, an ongoing study at AUH is evaluating the use of fiducial markers for bladder tumours. To further enable a reduction of the treatment margins used, Burridge et al [5] and Pos et al [6] have both suggested individual adaptation of the PTV based on multiple imaging of the CTV. In addition, a previous study has shown that correction of the isocentric position based on image guided RT (IGRT) could reduce the volume needed to enclose both planning and repeat CTVs [7].…”

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The normal tissue sparing potential of adaptive strategies in radiotherapy of bladder cancer

et al. 2008

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“…These involve acquisition of several images of patient anatomy on successive days, from which a composite clinical target volume (CTV) [and planning target volume (PTV)] is determined as the union of CTVs observed on each scan. Pos et al [14] used this approach to define a composite CTV based on the observed position on CT scans for the first five fractions, subsequently expanding 10 mm isotropically to a composite PTV. This allowed a 40% reduction in overall irradiated volume with minimal compromise to target coverage.…”

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confidence: 99%

Comparison of adaptive radiotherapy techniques for the treatment of bladder cancer

Webster

Stratford

Rodgers

et al. 2013

BJR

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Objective: Day-to-day anatomical variations complicate bladder cancer radiotherapy treatment. This work quantifies the impact on target coverage and irradiated normal tissue volume for different adaptive strategies. Methods: 20 patients were retrospectively planned using different three-dimensional conformal radiotherapy treatment strategies for whole-bladder carcinoma: (i) ''conventional'' treatment used isotropic expansion of the clinical target volume (CTV) by 15 mm to the planning target volume (PTV) for daily treatment; (ii) ''plan of the day'' used daily volumetric on-treatment imaging [cone beam CT (CBCT)] to select from four available plans with varying superior PTV margins; (iii) ''composite'' strategies used ontreatment CBCTs from Fractions 1-3 to inform a composite CTV and adapted PTV (5-and 10-mm margins for composite 1 and composite 2, respectively) for subsequent treatment. Target coverage was evaluated from available CBCTs (the first three fractions then the minimum weekly thereafter), and the reduction in the irradiated volume (i.e. within the 95% isodose) was quantified. Results: Plan of the day improved target coverage (i.e. all of the bladder within the 95% isodose throughout the treatment) relative to conventional treatment (p50.10), while no such benefit was observed with composite 2. Target coverage was reduced with composite 1 relative to conventional treatment. The mean irradiated volume was reduced by 17.2%, 35.0% and 14.6% relative to conventional treatment, for plan of the day, composite 1 and composite 2, respectively (p,0.01 in all cases). No parameters predictive of large changes in bladder volume later in the treatment were identified. Conclusions: Adaptive techniques can maintain or improve target coverage while allowing for reduced irradiated volume and possibly reduced toxicity. The plan-of-theday technique appeared to provide the optimal balance between target coverage and normal tissue sparing. Advances in knowledge: This study suggests that plan-of-the-day techniques will provide optimal outcomes for adaptive bladder radiotherapy.

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Adaptive Radiotherapy for Invasive Bladder Cancer, a Feasibility Study

Cited by 34 publications

References 0 publications

A review of the use of fiducial markers for image-guided bladder radiotherapy

A review of the use of fiducial markers for image-guided bladder radiotherapy

The normal tissue sparing potential of adaptive strategies in radiotherapy of bladder cancer

Comparison of adaptive radiotherapy techniques for the treatment of bladder cancer

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