ESTRO ACROP consensus guideline on CT- and MRI-based target volume delineation for primary radiation therapy of localized prostate cancer

Salembier, Carl; Villeirs, Geert; Bari, Berardino De; Hoskin, Peter; Pieters, Bradley R.; Vulpen, Marco van; Khoo, Vincent; Henry, Ann; Bossi, Alberto; Meerleer, Gert De; Fonteyne, Valérie

doi:10.1016/j.radonc.2018.01.014

Cited by 170 publications

(141 citation statements)

References 47 publications

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“…MR scan acquisition is based on a balanced steady-state free precession technique (True FISP) providing T2/T1-weighted contrast. The anatomy around the prostate exhibits similar contrast as in T2-weighted sequences, which is recommended for target volume delineation for primary radiation therapy of localized prostate cancer [21]. MR acquisition in the pelvic region for treatment planning at the MRIdian took between 65 and 172 s, depending on the scan range and field of view (FOV).…”

Section: Simulationmentioning

confidence: 99%

Clinical implementation of magnetic resonance imaging guided adaptive radiotherapy for localized prostate cancer

Tetar

Bruynzeel

Lagerwaard

et al. 2019

Physics and Imaging in Radiation Oncology

138

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A B S T R A C TBackground and purpose: Magnetic resonance-guided radiation therapy (MRgRT) has recently become available in clinical practice and is expected to expand significantly in coming years. MRgRT offers marker-less continuous imaging during treatment delivery, use of small clinical target volume (CTV) to planning target volume (PTV) margins, and finally the option to perform daily plan re-optimization. Materials and methods: A total of 140 patients (700 fractions) have been treated with MRgRT and online plan adaptation for localized prostate cancer since early 2016. Clinical workflow for MRgRT of prostate cancer consisted of patient selection, simulation on both MR-and computed tomography (CT) scan, inverse intensitymodulated radiotherapy (IMRT) treatment planning and daily plan re-optimization prior to treatment delivery with partial organs at risk (OAR) recontouring within the first 2 cm outside the PTV. For each adapted plan online patient-specific quality assurance (QA) was performed by means of a secondary Monte Carlo 3D dose calculation and gamma analysis comparison. Patient experiences with MRgRT were assessed using a patientreported outcome questionnaire (PRO-Q) after the last fraction. Results: In 97% of fractions, MRgRT was delivered using the online adapted plan. Intrafractional prostate drifts necessitated 2D-corrections during treatment in approximately 20% of fractions. The average duration of an uneventful fraction of MRgRT was 45 min. showed that MRgRT was generally well tolerated, with disturbing noise sensations being most commonly reported. Conclusions: MRgRT with daily online plan adaptation constitutes an innovative approach for delivering SBRT for prostate cancer and appears to be feasible, although necessitating extended timeslots and logistical challenges.

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Section: Simulationmentioning

confidence: 99%

Clinical implementation of magnetic resonance imaging guided adaptive radiotherapy for localized prostate cancer

Tetar

Bruynzeel

Lagerwaard

et al. 2019

Physics and Imaging in Radiation Oncology

138

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“…Usually, this task is done by radiation oncologists according to certain guidelines. 8,9 However, intra-and interobserver inconsistency has been noted due to different preferences and experience among radiation oncologists. 10,11 Typically, daily manual recontouring is not performed because it is time consuming and new anatomical variations may be introduced in the time it takes to delineate the scan.…”

Section: Introductionmentioning

confidence: 99%

Robust contour propagation using deep learning and image registration for online adaptive proton therapy of prostate cancer

et al. 2019

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PurposeTo develop and validate a robust and accurate registration pipeline for automatic contour propagation for online adaptive Intensity‐Modulated Proton Therapy (IMPT) of prostate cancer using software and deep learning.MethodsA three‐dimensional (3D) Convolutional Neural Network was trained for automatic bladder segmentation of the computed tomography (CT) scans. The automatic bladder segmentation alongside the computed tomography (CT) scan is jointly optimized to add explicit knowledge about the underlying anatomy to the registration algorithm. We included three datasets from different institutes and CT manufacturers. The first was used for training and testing the ConvNet, where the second and the third were used for evaluation of the proposed pipeline. The system performance was quantified geometrically using the dice similarity coefficient (DSC), the mean surface distance (MSD), and the 95% Hausdorff distance (HD). The propagated contours were validated clinically through generating the associated IMPT plans and compare it with the IMPT plans based on the manual delineations. Propagated contours were considered clinically acceptable if their treatment plans met the dosimetric coverage constraints on the manual contours.ResultsThe bladder segmentation network achieved a DSC of 88% and 82% on the test datasets. The proposed registration pipeline achieved a MSD of 1.29 ± 0.39, 1.48 ± 1.16, and 1.49 ± 0.44 mm for the prostate, seminal vesicles, and lymph nodes, respectively, on the second dataset and a MSD of 2.31 ± 1.92 and 1.76 ± 1.39 mm for the prostate and seminal vesicles on the third dataset. The automatically propagated contours met the dose coverage constraints in 86%, 91%, and 99% of the cases for the prostate, seminal vesicles, and lymph nodes, respectively. A Conservative Success Rate (CSR) of 80% was obtained, compared to 65% when only using intensity‐based registration.ConclusionThe proposed registration pipeline obtained highly promising results for generating treatment plans adapted to the daily anatomy. With 80% of the automatically generated treatment plans directly usable without manual correction, a substantial improvement in system robustness was reached compared to a previous approach. The proposed method therefore facilitates more precise proton therapy of prostate cancer, potentially leading to fewer treatment‐related adverse side effects.

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“…Prostate cancer (PCa) is one of the most common cancer in men worldwide. (1,2) Currently, radiotherapy is the standard of care for PCa patients. (3,4) The 5-year disease-free survival rates for PCa patients receiving external beam radiation therapy (EBRT) range between 67% and 91.2%.…”

Section: Introductionmentioning

confidence: 99%

“…(8)(9)(10) T2WI provide excellent soft-tissue contrast, allowing for the assessment of peritoneal involvement, and invasion in seminal vesicles and other adjacent tissues; (9)(10)(11) hence, T2WI MRI is currently the most promising method for PCa imaging. (2) High intra-target dose delivery in multifocal, non-uniform prostate tumors can improve local tumor control and patient prognosis. (2,11) According to the national comprehensive cancer network (NCCN) guidelines, delivery of 70-70.2 Gy in doses of 2.5-2.7 Gy is recommended for patients with PCa.…”

Section: Introductionmentioning

confidence: 99%

“…(2) High intra-target dose delivery in multifocal, non-uniform prostate tumors can improve local tumor control and patient prognosis. (2,11) According to the national comprehensive cancer network (NCCN) guidelines, delivery of 70-70.2 Gy in doses of 2.5-2.7 Gy is recommended for patients with PCa. (12) Since image quality affects the accuracy of target volume planning, improving image quality is critical for the success of radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Consistency Study of Multiparametric Magnetic Resonance and Computed Tomography Targeting in Targeted Radiotherapy for Prostate Cancer

Xu¹,

Li²,

Fu³

et al. 2020

Preprint

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Background: To compare the difference of location by computed tomography (CT) and multiparametric magnetic resonance imaging (mpMRI) on the target delineation and volume for organs at risk (OARs) among patients with prostate cancer. Methods: T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and CT were performed among 11 patients who received radiotherapy for prostate cancer at our center between August 2018 and December 2019. The target areas were delineated using the Eclipse system, and the radiotherapy plans were made based on the treatment planning system (TPS) to compare target volume and dose-volume histogram (DVH) relative to rectum and bladder. Results: The clinical target volume (CTV) of T1WI and T2WI decreased by 18.8% (P=0.001) and 22.72% (P=0.003), respectively, compared with CT. The planning target volume (PTV) on T1WI and T2WI were 20.45% (P=0.015) and 22.31% (P= 0.008) smaller than that defined by CT. There was no significant difference in either CTV or PTV between the areas outlined on T1WI and T2WI. The DVH resulting from CT and MRI comparisons showed that the rectum and bladder dose levels were lower with MRI images compared with CT. It should be noted that at the lateral directions, the range of outlining on T2WI sequence were significantly smaller than others. Conclusion: Target planning based on mpMRI (T1WI, T2WI) is more precise than CT, which can significantly reduce the range of the target area and the volume of rectum and bladder exposed to high levels of radiation, improve the fitness and radiographic accuracy of the target area, especially on T2WI.

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ESTRO ACROP consensus guideline on CT- and MRI-based target volume delineation for primary radiation therapy of localized prostate cancer

Abstract: The ESTRO consensus on CT/MRI based CTV delineation for primary RT of localized prostate cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency and reliability.

Cited by 170 publications

References 47 publications

Clinical implementation of magnetic resonance imaging guided adaptive radiotherapy for localized prostate cancer

Clinical implementation of magnetic resonance imaging guided adaptive radiotherapy for localized prostate cancer

Robust contour propagation using deep learning and image registration for online adaptive proton therapy of prostate cancer

Consistency Study of Multiparametric Magnetic Resonance and Computed Tomography Targeting in Targeted Radiotherapy for Prostate Cancer

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