The advanced radiotherapy network (ART-NET) UK lung stereotactic ablative radiotherapy survey: national provision and a focus on image guidance

Beasley, Matthew; Brown, Sean; McNair, Helen; Faivre-Finn, Corinne; Franks, K.; Murray, Louise; Herk, Marcel van; Henry, Ann

doi:10.1259/bjr.20180988

Cited by 10 publications

(14 citation statements)

References 21 publications

(22 reference statements)

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“…is is consistent with the results of two other published studies, which have also observed inconsistencies in follow-up surveillance in real-world practice, although both were conducted in single institutions (one in Ireland [27] and one in Italy [28]) before publication of the ENETS guidelines. Another study has also highlighted a similar lack of consensus for treatment options for pulmonary NETs across UK NHS centres [29]. Our results also suggest that CT scanning (the guideline-recommended imaging modality [8]) may not be utilised consistently in patient follow-up at all stages of the disease.…”

Section: Discussionmentioning

confidence: 68%

Diagnostic and Management Pathways for Pulmonary Carcinoid Tumours in the United Kingdom: Results from the National Lung Neuroendocrine Tumour Pathway Project

Mansoor

Ferguson

Ross

et al. 2020

International Journal of Endocrinology

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There is inconsistency among published guidelines for the optimal diagnostic and management pathways for patients with typical (TC) or atypical (AC) pulmonary carcinoid tumours. We conducted a UK-wide clinician survey to assess current practice for the diagnosis, management, and follow-up of patients with TC/AC and descriptively compared management between European Neuroendocrine Tumor Society (ENETS) accredited centres of excellence (CoE) and nonaccredited centres (non-CoE). Twenty-seven clinicians (10 CoE; 17 non-CoE) participated. Computed tomography of thorax, abdomen, and pelvis was the most commonly reported diagnostic tool (96% of respondents), and bone scans and gallium somatostatin receptor scintigraphy positron emission tomography (SRS PET) were the least commonly reported (30% and 37% of respondents, respectively). Adjuvant therapy is considered for resected TC/AC by <5% of respondents for patients with stage N0 M0 AC or TC, up to 48% of respondents for patients with AC with R1 disease. Somatostatin analogues were the most commonly reported first-line treatment (63% of respondents), and chemotherapy was the most commonly reported second-line therapy and third-line therapy (33% and 41%, respectively) for unresectable and metastatic disease. Reported frequency of initial follow-up after primary surgery ranged from every 2 months to annual, and total follow-up duration ranged from 2 years to indefinite depending on disease type (TC/AC) and stage. For most diagnostic investigations, the highest reported frequency of use was in CoE, most notably gallium SRS PET (70% CoE vs. 18% non-CoE respondents). 93% of respondents (100% CoE; 88% non-CoE) reported having neuroendocrine tumour- (NET-) specialist multidisciplinary team meetings at their centre; 59% (90% CoE; 41% non-CoE) had a NET Clinical Nurse Specialist (CNS) and 48% (80% CoE; 29% non-CoE) had a lung NET patient database. The survey results suggest variability between UK centres in diagnostic pathways and management of patients with TC/AC and suggest that CoE may be able to offer an improved service to patients.

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Section: Discussionmentioning

confidence: 68%

Diagnostic and Management Pathways for Pulmonary Carcinoid Tumours in the United Kingdom: Results from the National Lung Neuroendocrine Tumour Pathway Project

Mansoor

Ferguson

Ross

et al. 2020

International Journal of Endocrinology

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“…With further study, this ratio may be useful for clinical iGTV quality assessment, as a simple tool that can be extracted in many softwares. As MIP scans can underestimate tumor volume, a quality check is beneficial, especially for the 35% of UK centres using such a technique without systematically checking the coverage on individual phases 10 …”

Section: Discussionmentioning

confidence: 99%

“…The MIP approach incorporates both tumor volume and motion into a single delineation. Hence, for the 55% of UK SABR centres that adopt this approach, the GTV is never defined and not available for analysis of routine data 10 …”

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

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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.

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“…Comparable results focussing specifically on Lung SABR image-guided radiotherapy were recently published by the Cancer Research UK Advanced Radiotherapy Technologies Network (ARTNET) . 33 …”

Section: Discussionmentioning

confidence: 99%

Current status of stereotactic ablative body radiotherapy in the UK: six years of progress

et al. 2019

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Objective: To update the 2012 UK stereotacticablative radiotherapy (SABR) Consortium survey and assess the development of SABR services across the UK over the past 6 years. Use the results to share practice and continue to drive forward technique development, aid standardization and by highlighting issues, improve access to SABR services and trials across the UK. Methods: In January 2018, an online questionnaire was sent by the UK SABR Consortium to 65 UK radiotherapy institutions covering current service provision and collecting data on immobilization, motion management, scanning protocols, target/OAR delineation, planning, image-guidance, quality assurance and future plans. Results: 50 (77%) institutions responded, 38 ( vs 15 in 2012) indicated they had an active SABR programme with the remaining 12 centres intending to develop a SABR programme Documented changes include the development of Linac delivered SABR to non-lung sites, an increase in centres using abdominal compression (14 vs 2) and the introduction of four-dimensional cone beam CBCT. Current practice is broadly in line with UK SABR Consortium and European guidelines. Conclusion: This 2018 survey shows a welcome increase in SABR provision, surpassing 2012 projections. However, it is clear that the UK SABR program needs to continue to expand to ensure that patients with oligometastatic disease have access and SABR for early stage lung cancer is available in all centres. Updated guidance that addresses variability in target delineation, image guidance and reduces patient specific quality assurance is warranted. Advances in knowledge: Documented progress of UK SABR across all treatment sites over the last six years, barriers to implementation and future plans.

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The advanced radiotherapy network (ART-NET) UK lung stereotactic ablative radiotherapy survey: national provision and a focus on image guidance

Cited by 10 publications

References 21 publications

Diagnostic and Management Pathways for Pulmonary Carcinoid Tumours in the United Kingdom: Results from the National Lung Neuroendocrine Tumour Pathway Project

Diagnostic and Management Pathways for Pulmonary Carcinoid Tumours in the United Kingdom: Results from the National Lung Neuroendocrine Tumour Pathway Project

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

Current status of stereotactic ablative body radiotherapy in the UK: six years of progress

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