Cone beam CT-based dose accumulation and analysis of delivered dose to the dominant intraprostatic lesion in primary radiotherapy of prostate cancer

Tamihardja, Jörg; Cirsi, Sinan; Kessler, P.; Razinskas, Gary; Exner, Florian; Richter, Anne; Polat, Bülent; Flentje, Michael

doi:10.1186/s13014-021-01933-z

Cited by 12 publications

(12 citation statements)

References 22 publications

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“…There are many studies on the robustness evaluation of planning, but at present, there are few studies on the combination of o ine adaptive robustness evaluation and the comparison of planning methods. In a study, Tamihardja [21] conducted evaluation of VMAT robustness in prostate cancer and off-line adaptive evaluation of CBCT. Zhang's study also showed that rectal NTCPs in prostate cancer are highly affected by dose-to-dose variability in CBCT-based soft tissue matching.…”

Section: Discussionmentioning

confidence: 99%

“…In 2021, Buranaporn [4] studied the relationship between dose-received volume and complications of OARs during radiotherapy for bladder cancer, and the applied method was the fusion of CBCT and PCT using DIR for off-line adaptive radiotherapy. Tamihardja's [21] study also used CBCT-based off-line adaptive radiotherapy to assess the difference between actual dose and planned dose in prostate cancer. Wang's [22] study also compared dosimetry differences between daily and weekly CBCT using an MVCBCT-based off-line adaptive approach.…”

Section: Discussionmentioning

confidence: 99%

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Advantages and Robustness of Partial VMAT with Prone Position for Neoadjuvant Rectal Cancer Evaluated by CBCT-based Offline Adaptive Radiotherapy

Zhang

Peng

et al. 2023

Preprint

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Background and purpose: This study aims to explore the advantages and robustness of the partial arc combined with prone position planning technique for radiotherapy in rectal cancer patients. Adaptive radiotherapy is recalculated and accumulated on the synthesis CT (sCT) obtained by deformable image registration (DIR) between planning CT and cone beam CT (CBCT). Full and partial volume modulation arc therapy (VMAT) with the prone position on gastrointestinal and urogenital toxicity, based on the probability of normal tissue complications (NTCP) model in rectal cancer patients were evaluated. Materials and methods: Thirty-one patients were studied retrospectively. The contours of different structures were outlined in 155 CBCT images. First, full VMAT (F-VMAT) and partial VMAT (P-VMAT) planning techniques were processed and calculated using the same optimization constraints. The Acuros XB (AXB) algorithm was used in order to generate more realistic dose distributions and DVH, considering the air cavities. Second, the Velocity 4.0 software was used to fuse the planning CT and CBCT to obtain the sCT. Then, the AXB algorithm was used in the Eclipse 13.6 software to conduct re-calculation based on the sCT to obtain the corresponding dose. Furthermore, the LKB NTCP model was used to analyze its radiobiological side effects on the bladder and the bowel bag. Results: With a CTV coverage of 98%, when compared with F-VMAT, P-VMAT with the prone position technique can effectively reduce the mean dose of the bladder and the bowel bag. The LKB NTCP model showed that the P-VMAT combined with the prone planning technique resulted in a significantly lower complication probability of the bladder (1.88±2.08vs1.62±1.41, P=0.041) and the bowel bag (1.77 ± 2.90vs1.57 ± 2.36, P<0.001) than the F-VMAT. In terms of robustness, the P-VMAT is more robust than the F-VMAT, considering the fact that fewer changes were observed in the dose of the CTV, the bladder and the bowel bag. Conclusion: This study analyzed the advantages and robustness of the P-VMAT in the prone position from three aspects, based on the sCT fused by CBCT. Whether it is in regards to dosimetry, radiobiological effects or robustness, P-VMAT in the prone position has shown great advantages.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Advantages and Robustness of Partial VMAT with Prone Position for Neoadjuvant Rectal Cancer Evaluated by CBCT-based Offline Adaptive Radiotherapy

Zhang

Peng

et al. 2023

Preprint

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“…C-RAD systems can quantify setup errors in PMRT for breast cancer treatment. In our traditional radiation therapy, CBCT was a key method for assessing the positioning error (11,26). It enabled us to visualize important anatomical details in the patient's body.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, PMRT was used to treat patients who had no tumor tissue in the planning target, and the tumor location was close to the optical body surface, and thus, the impact could be minimized. Implementing adaptive radiotherapy (ART) might solve this problem (11). Additionally, the rotation of the patient in two directions (Pitch and Roll) were not accounted for.…”

Section: Discussionmentioning

confidence: 99%

“…To determine the dose distribution of the target volume and the OARs during treatment, the setup error needs to be considered (10). Some of the methods used for evaluating the setup errors are based on the value obtained by performing CBCT (11), but these methods may not pay much attention to the interfraction setup error. In this study, we performed surface guided monitoring to obtain the intrafraction and interfraction setup error for analysis (12,13), and then dose accumulation is performed to obtain a dose distribution for evaluating the robustness of all planning techniques.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Hybrid VMAT Advantages and Robustness Considering Setup Errors Using Surface Guided Dose Accumulation for Internal Lymph Mammary Nodes Irradiation of Postmastectomy Radiotherapy

Zhang

Li²,

Peng³

et al. 2022

Front. Oncol.

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ObjectivesSetup error is a key factor affecting postmastectomy radiotherapy (PMRT) and irradiation of the internal mammary lymph nodes is the most investigated aspect for PMRT patients. In this study, we evaluated the robustness, radiobiological, and dosimetric benefits of the hybrid volumetric modulated arc therapy (H-VMAT) planning technique based on the setup error in dose accumulation using a surface-guided system for radiation therapy.MethodsWe retrospectively selected 32 patients treated by a radiation oncologist and evaluated the clinical target volume (CTV), including internal lymph node irradiation (IMNIs), and considered the planning target volume (PTV) margin to be 5 mm. Three different planning techniques were evaluated: tangential-VMAT (T-VMAT), intensity-modulated radiation therapy (IMRT), and H-VMAT. The interfraction and intrafraction setup errors were analyzed in each field and the accumulated dose was evaluated as the patients underwent daily surface-guided monitoring. These parameters were included while evaluating CTV coverage, the dose required for the left anterior descending artery (LAD) and the left ventricle (LV), the normal tissue complication probability (NTCP) for the heart and lungs, and the second cancer complication probability (SCCP) for contralateral breast (CB).ResultsWhen the setup error was accounted for dose accumulation, T-VMAT (95.51%) and H-VMAT (95.48%) had a higher CTV coverage than IMRT (91.25%). In the NTCP for the heart, H-VMAT (0.04%) was higher than T-VMAT (0.01%) and lower than IMRT (0.2%). However, the SCCP (1.05%) of CB using H-VMAT was lower than that using T-VMAT (2%) as well as delivery efficiency. And T-VMAT (3.72) and IMRT (10.5).had higher plan complexity than H-VMAT (3.71).ConclusionsIn this study, based on the dose accumulation of setup error for patients with left-sided PMRT with IMNI, we found that the H-VMAT technique was superior for achieving an optimum balance between target coverage, OAR dose, complication probability, plan robustness, and complexity.

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Contour‐guided deep learning based deformable image registration for dose monitoring during CBCT‐guided radiotherapy of prostate cancer

Hémon

Rigaud

Barateau

et al. 2023

J Applied Clin Med Phys

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To evaluate deep learning (DL)-based deformable image registration (DIR) for dose accumulation during radiotherapy of prostate cancer patients. Methods and Materials: Data including 341 CBCTs (209 daily, 132 weekly) and 23 planning CTs from 23 patients was retrospectively analyzed. Anatomical deformation during treatment was estimated using free-form deformation (FFD) method from Elastix and DL-based VoxelMorph approaches. The VoxelMorph method was investigated using anatomical scans (VMorph_Sc) or label images (VMorph_Msk), or the combination of both (VMorph_Sc_Msk). Accumulated doses were compared with the planning dose. Results: The DSC ranges, averaged for prostate, rectum and bladder, were 0.60-0.71, 0.67-0.79, 0.93-0.98, and 0.89-0.96 for the FFD, VMorph_Sc, VMorph_Msk, and VMorph_Sc_Msk methods, respectively. When including both anatomical and label images, VoxelMorph estimated more complex deformations resulting in heterogeneous determinant of Jacobian and higher percentage of deformation vector field (DVF) folding (up to a mean value of 1.90% in the prostate). Large differences were observed between DL-based methods regarding estimation of the accumulated dose, showing systematic overdosage and underdosage of the bladder and rectum, respectively. The difference between planned mean dose and accumulated mean dose with VMorph_Sc_Msk reached a median value of +6.3 Gy for the bladder and −5.1 Gy for the rectum. Conclusion:The estimation of the deformations using DL-based approach is feasible for male pelvic anatomy but requires the inclusion of anatomical contours to improve organ correspondence. High variability in the estimation of the accumulated dose depending on the deformable strategy suggests further investigation of DL-based techniques before clinical deployment.

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Cone beam CT-based dose accumulation and analysis of delivered dose to the dominant intraprostatic lesion in primary radiotherapy of prostate cancer

Cited by 12 publications

References 22 publications

Advantages and Robustness of Partial VMAT with Prone Position for Neoadjuvant Rectal Cancer Evaluated by CBCT-based Offline Adaptive Radiotherapy

Advantages and Robustness of Partial VMAT with Prone Position for Neoadjuvant Rectal Cancer Evaluated by CBCT-based Offline Adaptive Radiotherapy

Evaluation of Hybrid VMAT Advantages and Robustness Considering Setup Errors Using Surface Guided Dose Accumulation for Internal Lymph Mammary Nodes Irradiation of Postmastectomy Radiotherapy

Contour‐guided deep learning based deformable image registration for dose monitoring during CBCT‐guided radiotherapy of prostate cancer

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