Correlating Dose Variables with Local Tumor Control in Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer: A Modeling Study on 1500 Individual Treatments

Klement, Rainer J.; Sonke, Jan‐Jakob; Allgäuer, Michael; Andratschke, Nicolaus; Appold, Steffen; Belderbos, J.; Belka, Claus; Blanck, Oliver; Dieckmann, Karin; Eich, Hans Theodor; Mantel, Frederick; Eble, Michael J.; Hope, Andrew; Grosu, Anca L.; Nevinny-Stickel, Meinhard; Semrau, Sabine; Sweeney, Reinhart A.; Hörner-Rieber, Juliane; Werner‐Wasik, Maria; Engenhart‐Cabillic, Rita; Ye, Hong; Grills, I.S.; Gückenberger, Matthias

doi:10.1016/j.ijrobp.2020.03.005

Cited by 47 publications

(38 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Loi et al found BED 10 > 75 Gy was associated with higher LC rate [14]. In a modelling study, Klement et al showed that in lung SBRT, the following BED 10 of PTV were predictive of LC rate: D 1% , prescribed dose [30]. Such a link was not found in our study but Klement's study was not speci cally about ultra-central tumours.…”

Section: Discussioncontrasting

confidence: 65%

Toxicity and Efficacy of Stereotactic Body Radiotherapy for Ultra-central Lung Tumours: a Single Institution Real Life Experience

GUILLAUME

Tanguy

Ayadi

et al. 2021

Preprint

View full text Add to dashboard Cite

Purpose: The use of stereotactic body radiotherapy (SBRT) to treat ultra-central lung tumours remains more controversial than for peripheral and central tumours. We carried out a study about SBRT in patients with ultra-central lung tumours treated in our Cancer Centre. Our objectives were to assess toxicities, local control (LC) rate and survival data.Methods: We conducted a retrospective and monocentric study about 74 patients with an ultra-central lung tumour, consecutively treated between 2012 and 2018. Ultra-central tumours were defined as tumours whose PTV (planning target volume) overlapped one of the following organs at risk (OAR): the trachea, right and left main bronchi, intermediate bronchus, lobe bronchi, oesophagus, heart. Patients with primary or secondary tumour were enrolled in the study.Results: Median follow-up was 25 months. Two patients (2.7%) showed grade 3 toxicity. No grade 4 or 5 toxicity was observed. Eleven per cent of patients experienced primary local relapse. Local control rate was 96.7% at 1 year and 87.6% at 2 years. Median progression free survival (PFS) was 12 months. Median overall survival (OS) was 31 months. Conclusions: SBRT for ultra-central tumours remains safe and effective. Thus, SBRT can be considered to be well tolerated as long as protecting organs at risk remains treatment planning priority. Besides, as the results of ongoing prospective trial have not been published yet, SBRT for ultra-central tumours should be performed with caution.

show abstract

Section: Discussioncontrasting

confidence: 65%

Toxicity and Efficacy of Stereotactic Body Radiotherapy for Ultra-central Lung Tumours: a Single Institution Real Life Experience

GUILLAUME

Tanguy

Ayadi

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…All mean changes larger than 1% are marked in bold. GTV meaning that it was possible to maintain a high effective dose in the online-adaptive workflow [24,25]. Nevertheless, some changes in PTV-and GTV dose parameters may seem larger than expected in treatments on the conventional linac.…”

Section: Discussionmentioning

confidence: 99%

“…The same is the case for the GTV-D mean , which is considered an important parameter for local tumor control. Small changes compared to the reference plan were observed in the online-adapted plans; meaning that it was possible to maintain a high effective dose in the online-adaptive workflow [ 24 , 25 ]. Nevertheless, some changes in PTV- and GTV dose parameters may seem larger than expected in treatments on the conventional linac.…”

Section: Discussionmentioning

confidence: 99%

Treatment plan quality during online adaptive re-planning

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: Online adaptive radiotherapy is intended to prevent plan degradation caused by inter-fractional tumor volume and shape changes, but time limitations make online re-planning challenging. The aim of this study was to compare the quality of online-adapted plans to their respective reference treatment plans. Methods: Fifty-two patients treated on a ViewRay MRIdian Linac were included in this retrospective study. In total 238 online-adapted plans were analyzed, which were optimized with either changing of the segment weights (n = 85) or full re-optimization (n = 153). Five different treatment sites were evaluated: prostate, abdomen, liver, lung and pelvis. Dosimetric parameters of gross tumor volume (GTV), planning target volume (PTV), 2 cm ring around the PTV and organs at risk (OARs) were considered. The Wilcoxon signed-rank test was used to assess differences between online-adapted and reference treatment plans, p < 0.05 was considered significant. Results: The average duration of the online adaptation, consisting of contour editing, plan optimization and quality assurance (QA), was 24 ± 6 min. The GTV was slightly larger (average ± SD: 1.9% ± 9.0%) in the adapted plans than in the reference plans (p < 0.001). GTV-D 95% exhibited no significant changes when considering all plans, but GTV-D 2% increased by 0.40% ± 1.5% on average (p < 0.001). There was a very small yet significant decrease in GTVcoverage for the abdomen plans. The ring D mean increased on average by 1.0% ± 3.6% considering all plans (p < 0.001). There was a significant reduction of the dose to the rectum of 4.7% ± 16% on average (p < 0.001) for prostate plans. Conclusions: Dosimetric quality of online-adapted plans was comparable to reference treatment plans and OAR dose was either comparable or decreased, depending on treatment site. However, dose spillage was slightly increased.

show abstract

“…In retrospective analysis, the GTV volume and shape are important parameters for prognostic and dose modeling 11,12 . Also, radiomic features describing the GTV and surrounding tissue have been linked to local control, metastasis, and overall survival 13–15 .…”

Section: Introductionmentioning

confidence: 99%

“…10 In retrospective analysis, the GTV volume and shape are important parameters for prognostic and dose modeling. 11,12 Also, radiomic features describing the GTV and surrounding tissue have been linked to local control, metastasis, and overall survival. [13][14][15] So far, there are few radiomic studies using 4D-CT data unless a GTV has been delineated within the clinical protocol, 11,14 or retrospective contouring is performed.…”

Section: Introductionmentioning

confidence: 99%

Automated gross tumor volume contour generation for large‐scale analysis of early‐stage lung cancer patients planned with 4D‐CT

et al. 2020

View full text Add to dashboard Cite

Purpose: Patients with early-stage lung cancer undergoing stereotactic ablative radiotherapy receive four-dimensional computed tomography (4D-CT) for treatment planning. Often, an internal gross target volume (iGTV), which approximates the motion envelope of a tumor over the breathing cycle, is delineated without defining a gross tumor volume (GTV). However, the GTV volume and shape are important parameters for prognostic and dose modelling, and there is interest in radiomic features extracted from the GTV and surrounding tissue. We demonstrate and validate a method to generate the GTV from an iGTV contour to aid retrospective analysis on routine data. Method: It is possible to reconstruct the geometry of a tumor with knowledge of tumor motion and the motion envelope formed during respiration. To demonstrate this, the tumor motion path was estimated with local rigid registration, and the iGTV positioned incrementally at stations along the reverse path. It is shown that the tumor volume is the largest set common to the intersection of the iGTV at these positions, hence can be derived. This was implemented for 521 lung lesions on 4D-CT. Eleven patients with a GTV delineation performed by a radiation oncologist on a reference phase (50%) were used for validation. The generated GTV was compared to that delineated by the expert using distance-to-agreement (DTA), volume, and distance between centres of mass. An overall success rate was determined by detecting registration inaccuracy and performing a quality check on the routine iGTV. For successfully generated contours, GTV volume was compared to iGTV volume in a prognostic model for overall survival. Results: For the validation dataset, DTA mean (0.79-1.55 mm) and standard deviation (0.68-1.51 mm) were comparable to expected observer variation. Difference in volume was < 5 cm 3 , and average difference in position was 1.21 mm. Deviations in shape and position were mainly caused by observer differences in iGTV and GTV interpretation as opposed to algorithm performance. For the complete dataset, an acceptable contour was generated for 94% of patients using statistical and visual assessment to detect failures. Generated GTV volumes improved prognostic model performance over iGTV volumes. Conclusion: A method to generate a GTV from an iGTV and 4D-CT dataset was developed. This method facilitates data analysis of patients with early-stage lung cancer treated in the routine setting, that is, data mining, prognostic modeling, and radiomics. Generation failure detection removes the need for visual assessment of all contours, reducing a time-consuming aspect of big-data analysis. Favorable prognostic performance of generated GTV volumes over iGTV ones demonstrates opportunities to use this methodology for future study.

show abstract

Correlating Dose Variables with Local Tumor Control in Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer: A Modeling Study on 1500 Individual Treatments

Cited by 47 publications

References 40 publications

Toxicity and Efficacy of Stereotactic Body Radiotherapy for Ultra-central Lung Tumours: a Single Institution Real Life Experience

Toxicity and Efficacy of Stereotactic Body Radiotherapy for Ultra-central Lung Tumours: a Single Institution Real Life Experience

Treatment plan quality during online adaptive re-planning

Automated gross tumor volume contour generation for large‐scale analysis of early‐stage lung cancer patients planned with 4D‐CT

Contact Info

Product

Resources

About