Clinical assessment of coiled fiducial markers as internal surrogates for hepatocellular carcinomas during gated stereotactic body radiotherapy with a real-time tumor-tracking system

Hanazawa, Hideki; Takahashi, Shunsaku; Shiinoki, Takehiro; Park, Sung Chul; Yuasa, Yuki; Koike, Masato; Kawamura, Shinji; Shibuya, Kazuhiko

doi:10.1016/j.radonc.2017.02.010

Cited by 17 publications

(15 citation statements)

References 22 publications

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“…Endovascular coils have also been used as markers for lung tumours (Prévost et al 2008 ). Thinner markers that can take an irregular shape (figure 3(b) ) may be preferred to regularly shaped markers to limit artefacts in reconstructed volumetric images or the risk of migration or implantation complication (Hanazawa et al 2017 , Castellanos et al 2018 ). Liquid FMs such as Lipiodol (Guerbet, France) (Rose et al 2014 ) or BioXmark (figure 3(c) ) allow for a personalized injected volume, reduced artefacts in reconstructed volume images and reduced dose perturbation for particle therapy at the cost of lower contrast in x-ray projection images.…”

Section: Real-time Intrafraction Motion Monitoring Methodsmentioning

confidence: 99%

“…The linac and the kV imaging system pulses are synchronized such that the kV images are free from MV scatter. Thirty kV image pairs are acquired per second and used to detect a spherical or Visicoil (Hanazawa et al 2017 ) FM using a simple template matching algorithm. Beam interlocks are set if the cross-correlation coefficient is too low or if the line of sight of the marker in the two imagers are further apart than 1.5 mm.…”

Section: Real-time Intrafraction Motion Monitoring Methodsmentioning

confidence: 99%

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Real-time intrafraction motion monitoring in external beam radiotherapy

et al. 2019

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Radiotherapy (RT) aims to deliver a spatially conformal dose of radiation to tumours while maximizing the dose sparing to healthy tissues. However, the internal patient anatomy is constantly moving due to respiratory, cardiac, gastrointestinal and urinary activity. The long term goal of the RT community to ‘see what we treat, as we treat’ and to act on this information instantaneously has resulted in rapid technological innovation. Specialized treatment machines, such as robotic or gimbal-steered linear accelerators (linac) with in-room imaging suites, have been developed specifically for real-time treatment adaptation. Additional equipment, such as stereoscopic kilovoltage (kV) imaging, ultrasound transducers and electromagnetic transponders, has been developed for intrafraction motion monitoring on conventional linacs. Magnetic resonance imaging (MRI) has been integrated with cobalt treatment units and more recently with linacs. In addition to hardware innovation, software development has played a substantial role in the development of motion monitoring methods based on respiratory motion surrogates and planar kV or Megavoltage (MV) imaging that is available on standard equipped linacs. In this paper, we review and compare the different intrafraction motion monitoring methods proposed in the literature and demonstrated in real-time on clinical data as well as their possible future developments. We then discuss general considerations on validation and quality assurance for clinical implementation. Besides photon RT, particle therapy is increasingly used to treat moving targets. However, transferring motion monitoring technologies from linacs to particle beam lines presents substantial challenges. Lessons learned from the implementation of real-time intrafraction monitoring for photon RT will be used as a basis to discuss the implementation of these methods for particle RT.

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Section: Real-time Intrafraction Motion Monitoring Methodsmentioning

confidence: 99%

Section: Real-time Intrafraction Motion Monitoring Methodsmentioning

confidence: 99%

Real-time intrafraction motion monitoring in external beam radiotherapy

et al. 2019

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“…Compared to surgery patients treated with RFA have noticeably lower morbidity (9%, p ¼ .003) [37]. In the present analysis, most of the toxicities were laboratory abnormalities which are most often transient after SBRT treatment or may have been attributable to preceding TACE [14,40]. It is important to consider that the low incidence of early toxicities may be due to underreporting both in patients treated with SBRT and RFA.…”

Section: Discussionmentioning

confidence: 62%

Stereotactic body radiation therapy for early-stage hepatocellular carcinoma – a systematic review on outcome

et al. 2019

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Background: Hepatocellular carcinoma (HCC) incidence is rising worldwide, especially due to increased detection of early-stage or small-sized tumors. Nevertheless, most of the patients are still not qualified for surgical resection at diagnosis due to the localization of the tumor, underlying liver disease or comorbidities. Stereotactic body radiation therapy (SBRT) is a radiotherapy modality which can deliver a high dose of radiation to the target tissue with a high degree of precision. It shows promise in terms of efficacy and morbidity. Material and methods: The aim of this systematic review is to summarize current knowledge on patient-specific outcomes of SBRT for small HCC including overall survival, local control, the effect of dose escalation and the toxicity of the treatment. The systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After a comprehensive database search, 16 studies (973 patients with 1034 lesions) were included in qualitative and quantitative analyses; 14 of them were retrospective. Results: Average tumor diameter was 23 mm and 95% of patients were in good general condition. Median BED10 (biologically equivalent dose calculated for a/b ratio of 10 Gy) was 100 Gy (range 59.5-180 Gy). Mean weighted local control across studies was 94%, 92% and 93% at 1, 2, and 3 years, respectively. Mean weighted overall survival across studies was 90.9%, 67.5% and 73.4% at 1, 2, and 3 years, respectively. There were 171 grade 1-2 toxicities (17.5%) and 53 ! grade 3 toxicities (5.3%). There was no treatment-associated mortality. Conclusion: SBRT offers high local control with overall survival that is comparable with radiofrequency ablation and surgery. Quality of findings, especially on toxicities, is decreased by incomplete reporting and retrospective designs of published studies. Therefore, there is a need for better reporting and prospective studies to univocally recommend SBRT as a definitive treatment option in the guidelines for small HCCs.

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“…This results in a lower dose to normal tissues and, consequently, a lower risk of complications. 10 In a preliminary study, our group reported that this system can track the motion of a fiducial marker and control radiation delivery with reasonable accuracy. 2 Flattening filter free (FFF) respiratorygated SBRT of a lung tumor was performed using this system in September 2015.…”

Section: Introductionmentioning

confidence: 99%

A novel dynamic robotic moving phantom system for patient‐specific quality assurance in real‐time tumor‐tracking radiotherapy

Shiinoki

Fujii

Fujimoto

et al. 2020

J Applied Clin Med Phys

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In this study, we assess a developed novel dynamic moving phantom system that can reproduce patient three-dimensional (3D) tumor motion and patient anatomy, and perform patient-specific quality assurance (QA) of respiratory-gated radiotherapy using SyncTraX. Three patients with lung cancer were enrolled in a study. 3D printing technology was adopted to obtain individualized lung phantoms using CT images. A water-equivalent phantom (WEP) with the 3D-printed plate lung phantom was set at the tip of the robotic arm. The log file that recorded the 3D positions of the lung tumor was used as the input to the dynamic robotic moving phantom. The WEP was driven to track 3D respiratory motion. Respiratory-gated radiotherapy was performed for driving the WEP. The tracking accuracy was calculated as the differences between the actual and measured positions. For the absolute dose and dose distribution, the differences between the planned and measured doses were calculated. The differences between the planned and measured absolute doses were <1.0% at the isocenter and <4.0% for the lung region. The gamma pass ratios of γ 3 mm/3% and γ 2 mm/2% under the conditions of gating and no-gating were 99.9 ± 0.1% and 90.1 ± 8.5%, and 97.5 ± 0.9% and 68.6 ± 17.8%, respectively, for all the patients. Furthermore, for all the patients, the mean ± SD of the root mean square values of the positional error were 0.11 ± 0.04 mm, 0.33 ± 0.04 mm, and 0.20 ± 0.04 mm in the LR, AP, and SI directions, respectively. Finally, we showed that patient-specific QA of respiratory-gated radiotherapy using SyncTraX can be performed under realistic conditions using the moving phantom.

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Clinical assessment of coiled fiducial markers as internal surrogates for hepatocellular carcinomas during gated stereotactic body radiotherapy with a real-time tumor-tracking system

Cited by 17 publications

References 22 publications

Real-time intrafraction motion monitoring in external beam radiotherapy

Real-time intrafraction motion monitoring in external beam radiotherapy

Stereotactic body radiation therapy for early-stage hepatocellular carcinoma – a systematic review on outcome

A novel dynamic robotic moving phantom system for patient‐specific quality assurance in real‐time tumor‐tracking radiotherapy

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