Role of perfusion CT in the evaluation of functional primary tumour response after radiochemotherapy in head and neck cancer: preliminary findings

Ursino, Stefano; Faggioni, Lorenzo; Guidoccio, Federica; Ferrazza, P.; Seccia, Veronica; Neri, Emanuele; Cernusco, L.; Delishaj, D.; Morganti, Riccardo; Volterrani, Duccio; Paiar, Fabiola; Caramella, Davide

doi:10.1259/bjr.20151070

Cited by 10 publications

(5 citation statements)

References 35 publications

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“…For this reason IMRT is ideal for the treatment of H&N cancer and recent studies showed that IMRT can potentially improve local–regional control, reduce side effects especially xerostomia, and improve quality of life [ 10 - 16 ].…”

Section: Introductionmentioning

confidence: 99%

Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: a feasible protocol

et al. 2018

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PurposeTo investigate set-up errors, suggest the adequate planning target volume (PTV) margin and image-guided radiotherapy frequency in head and neck (H&N) cancer treated with intensity-modulated radiotherapy (IMRT) assessed by kV cone-beam computed tomography (CBCT).MethodsWe analyzed 360 CBCTs in 60 patients with H&N cancer treated with IMRT. The target delineation was contoured according to ICRU62. PTVs were generated by adding a 3–5 mm margin in all directions to the respective clinical target volumes. The kV CBCT images were obtained at first three days of irradiation and weekly thereafter. The overall mean displacement, range, systematic (∑) and random (σ) errors were calculated. Adequate PTV margins were calculated according to the van Herk formula (2.5∑ + 0.7r).ResultsThe mean of set-up errors was less than 2 mm in any direction. The overall frequency of set-up displacements greater than 3 mm was 3.9% in medial-lateral (ML) direction, 8% in superior-inferior (SI) direction, and 15.5% in anterior-posterior (AP) direction. The range of translations shifts was 0–9 mm in ML direction, 0–5 mm in SI direction and 0–10 mm in AP direction, respectively. After systematic set-up errors correction, the adequate margin to overcome the problem of set-up errors was found to be less than 3 mm.ConclusionImage-guided kV CBCT was effective for the evaluation of set-up accuracy in H&N cancer. The kV CBCT at first three fractions and followed-by weekly appears adequate for reducing significantly set-up errors in H&N cancer treated with IMRT technique. Finally, 3–5 mm PTV margins appear adequate and safe to overcome the problem of set-up errors.

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Section: Introductionmentioning

confidence: 99%

Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: a feasible protocol

et al. 2018

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“…In theory, tumours from different tissues or different pathological types of the same tumour can be identified using these parameters. CT perfusion imaging has been used in the differential diagnosis of squamous cell carcinoma of the head and neck, as well as in the prognosis and posttreatment response evaluation of neck lymphoma [27][28][29] . Each pure substance has a specific spectral attenuation curve, and X-ray attenuation in various tissues can be expressed by a pair of known pure substances 30,31 .…”

Section: Discussionmentioning

confidence: 99%

Dual-energy CT perfusion imaging for differentiating WHO subtypes of thymic epithelial tumors

Zhang

et al. 2020

Sci Rep

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To evaluate the role of conventional contrast-enhanced CT (CECT) imaging and dual-energy spectral CT (DECT) perfusion imaging in differentiating the WHO histological subtypes of thymic epithelial tumours (TETs). Eighty-eight patients with TETs who underwent DECT perfusion scans (n = 51) and conventional CT enhancement scans (n = 37) using a GE Discovery CT750 HD scanner were enrolled in this study. The mean maximal contrast-enhanced range (mean CEmax) and the perfusion and spectral parameters of the lesions were analysed. Among the six WHO subtypes (Type A, AB, B1, B2, and B3 thymoma and thymic carcinoma), the mean CEmax values and most of the perfusion and spectral parameter values of Type A and Type AB were significantly higher than those of the other subtypes (all P < 0.05), and there was no difference among Type B1, B2 and B3 (all P > 0.05). The mean CEmax value was not different between Type B (including Type B1, B2, and B3) and thymic carcinoma (P = 1.000). The PS, IC, NIC and λ HU values in the optimal venous phase of thymic carcinoma were higher than those of Type B (all p < 0.05). The parameters of conventional CECT imaging and DECT perfusion imaging can help identify the subtype of TETs, especially those of DECT perfusion imaging in type B thymomas and thymic carcinomas.

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“…Studies have shown that IMRT may be an ideal technique for the treatment of head and neck cancers as it improves quality of life by improving locoregional control and reducing side effects (especially xerostomia). [18][19][20][21][22][23][24] The improved dose conformality that is achieved with IMRT requires greater accuracy in treatment planning and registration during the course of radiation, because reduced target delineation causes set-up errors. Several studies had investigated set-up errors in head and neck cancers and analysed the required number (N) of first fractions to be imaged to detect systematic errors.…”

Section: Discussionmentioning

confidence: 99%

Prospective observational study to estimate set-up errors and optimise PTV margins in patients undergoing IMRT for head and neck cancers from a Government cancer centre of Eastern India

Biswas

Lahiri

et al. 2019

J Radiother Pract

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Background:The head and neck cancers as a whole are the most common cancers among males in India. Technological advancements have led to an improvement in radiation therapy (RT) techniques with subsequent reduction in normal tissue complications. To correct patient set-up errors, an off-line correction method like no action level (NAL) protocol may be used as a preferred protocol particularly for a busy department. The objectives of the study were to measure the translational set-up errors using kV cone-beam computed tomography (CBCT) in patients undergoing intensity modulated radiotherapy (IMRT) in head and neck cancers and also to optimise clinical target volume (CTV) to planning target volume (PTV) margin using NAL protocol.Material and methods:On the first 5 days of RT, patient’s position was verified by kV-CBCT and then weekly during the course of treatment. The comparison between the reference and kV-CBCT images was performed, and the shifts measured and recorded. The mean error from the initial five consecutive fractions was corrected on the sixth daily fraction. Displacements in all the directions were measured. The population systematic and random errors were determined and used to estimate PTV margins according to the van Herk formula.Results:A total of 322 images were analysed. Before correction, 15, 12 and 9% patients had systematic error ≥3 mm on X, Y and Z axes, but after correction this was reduced to 9, 0 and 0%. The total percentage of patients whose set-up margin was ≥5 mm before correction was 5, 6·25, 3·75%, but after correction it reduced to 1·88, 0, and 0·63%. The margins of total population were reduced to 63, 65 and 56% after correction on X, Y and Z axes, respectively.Conclusion:A simple off-line NAL protocol can correct the set-up errors without daily on-line imaging in patients undergoing IMRT and hence acting as a resource sparing alternative. Five millimetre margin to CTVs was adequate and safe to overcome the problem of set-up errors in head and neck IMRT.

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Role of perfusion CT in the evaluation of functional primary tumour response after radiochemotherapy in head and neck cancer: preliminary findings

Cited by 10 publications

References 35 publications

Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: a feasible protocol

Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: a feasible protocol

Dual-energy CT perfusion imaging for differentiating WHO subtypes of thymic epithelial tumors

Prospective observational study to estimate set-up errors and optimise PTV margins in patients undergoing IMRT for head and neck cancers from a Government cancer centre of Eastern India

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