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Image Guided Radiotherapy

Jacques Bernier
The increasing use of nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) in the treatment of nonmetastatic breast cancer is justified by considerations linked to their therapeutic index. In selected patients, efficacy results tend to be similar to those observed after radical modified mastectomy and at the same time, subcutaneous mastectomies preserve the patient's body image. Yet the oncologic safety of the two former surgical approaches is still a matter of debate, also in consideration of the almost complete absence of clinical studies directed to prospective, controlled comparisons between subcutaneous and radical modified mastectomies...
2018: Ecancermedicalscience
Corinne N Johnson, Gareth J Price, Corinne Faivre-Finn, Marianne C Aznar, Marcel van Herk
BACKGROUND: and Purpose: Image-guided radiotherapy (IGRT) is widely used but data directly relating setup errors to patient outcome is scarce. This study investigates the relationship between residual IGRT shifts and overall patient survival, and uses the observed relations to identify structures sensitive to radiation dose. MATERIALS AND METHODS: Residual shift data for 780 NSCLC patients was summarised for each patient over the course of treatment by determining the mean shifts, standard deviations and the vector shift in the direction of the heart...
June 1, 2018: International Journal of Radiation Oncology, Biology, Physics
Radka Stoyanova, Felix Chinea, Deukwoo Kwon, Isildinha M Reis, Yohann Tschudi, Nestor A Parra, Adrian L Breto, Kyle R Padgett, Alan Dal Pra, Matthew C Abramowitz, Oleksandr N Kryvenko, Sanoj Punnen, Alan Pollack
PURPOSE: To develop a prostate tumor habitat risk scoring (HRS) system based on multiparametric MRI (mpMRI) referenced to prostatectomy Gleason Score (GS) for automatic delineation of Gross Tumor Volumes (GTVs). A workflow for integration of HRS into radiotherapy (RT) boost volume dose escalation was developed in the framework of a Phase II randomized clinical trial (BLaStM). MATERIALS AND METHODS: An automated quantitative mpMRI based 10 point pixel by pixel method was optimized to prostatectomy GSs and volumes using referenced Dynamic Contrast Enhanced and Apparent Diffusion Coefficient sequences...
June 13, 2018: International Journal of Radiation Oncology, Biology, Physics
E Vigneault, G Morton, W R Parulekar, T M Niazi, C W Springer, M Barkati, P Chung, W Koll, A Kamran, M Monreal, K Ding, A Loblaw
AIMS: We conducted a multicentre feasibility study to assess the ability to randomise patients between image-guided radiotherapy (IGRT) and IGRT + high dose rate (HDR) brachytherapy boost and to adhere to appropriate radiation quality assurance standards. MATERIALS AND METHODS: The primary end point was to determine the ability to randomise 60 patients over an 18 month period. Arm 1 (IGRT) patients received 78 Gy in 39 fractions or 60 Gy in 20 fractions (physician's preference), whereas arm 2 (IGRT + HDR) received 37...
June 11, 2018: Clinical Oncology: a Journal of the Royal College of Radiologists
Hans Ligtenberg, Tim Schakel, Jan Willem Dankbaar, Lilian N Ruiter, Boris Peltenburg, Stefan M Willems, Nicolien Kasperts, Chris H J Terhaard, Cornelis P J Raaijmakers, Marielle E P Philippens
In radiotherapy treatment planning, tumor delineation based on diffusion-weighted imaging (DWI) by magnetic resonance imaging (MRI) is a promising technique. MR-only-based target definition becomes important with the recent development of MRI integrated radiotherapy treatment modalities. In this case series, DWI-based gross tumor volume (GTV) was validated using pathology and compared with a clinical GTV based on computed tomography (CT) imaging and MRI. This case series includes three patients with a laryngeal tumor...
April 11, 2018: Curēus
M Martišíková, T Gehrke, S Berke, G Aricò, O Jäkel
BACKGROUND: Ion beam radiotherapy provides potential for increased dose conformation to the target volume. To translate it into a clinical advantage, it is necessary to guarantee a precise alignment of the actual internal patient geometry with the treatment beam. This is in particular challenging for inter- and intrafractional variations, including movement. Ion beams have the potential for a high sensitivity imaging of the patient geometry. However, the research on suitable imaging methods is not conclusive yet...
June 14, 2018: Radiation Oncology
Olalla Santa Cruz, Pelagia Tsoutsou, Cyril Castella, Kaouthar Khanfir, Sandro Anchisi, Salim Bouayed, Oscar Matzinger, Mahmut Ozsahin
OBJECTIVES: To assess the feasibility and efficacy of intensity-modulated radiation implemented with helical tomotherapy image-guided with daily megavoltage computed tomography for head and neck cancer. METHODS: Between May 2010 and May 2013, 72 patients were treated with curative intent. The median age was 64 years, with 57% undergoing definitive and 43% postoperative radiotherapy. Primary tumour sites were oral cavity (21%), oropharynx (26%), hypopharynx (20%), larynx (22%), and others (11%)...
June 12, 2018: Oncology
Yoshiko Doi, Yuji Murakami, Nobuki Imano, Yuki Takeuchi, Ippei Takahashi, Ikuno Nishibuchi, Tomoki Kimura, Yasushi Nagata
INTRODUCTION: Cardiac toxicity after definitive chemoradiotherapy for esophageal cancer is a critical issue. To reduce irradiation doses to organs at risk, individual internal margins need to be identified and minimized. The purpose of this study was to quantify esophageal motion using fiducial makers based on four-dimensional computed tomography, and to evaluate the inter-CBCT session marker displacement using breath-hold. MATERIALS AND METHODS: Sixteen patients with early stage esophageal cancer, who received endoscopy-guided metallic marker placement for treatment planning, were included; there were 35 markers in total, with 9, 15, and 11 markers in the upper thoracic, middle thoracic, and lower thoracic/esophagogastric junction regions, respectively...
2018: PloS One
Karthik S Rishi, Ram Charith Alva, Amrit Raghav Kadam, Sanjiv Sharma
Locally advanced cancer of the cervix is treated by concurrent chemoradiation followed by brachytherapy. Interstitial brachytherapy is used to treat large tumors with involvement of parametrium, post-hysterectomy, and narrow, conical vagina. The GYN GEC-ESTRO working group described target volume delineation and also 3D image-based planning using MRI and 3D dose-volume parameters for brachytherapy of carcinoma cervix. CT-based as compared to MR-based image-guided brachytherapy (IGBT) is much more feasible and practical because MR access is still difficult for most departments...
June 2018: Indian Journal of Surgical Oncology
Renáta Kószó, Linda Varga, Emese Fodor, Zsuzsanna Kahán, Adrienne Cserháti, Katalin Hideghéty, Zsófia Együd, Csilla Szabó, Emőke Borzási, Dorottya Szabó, Kitti Müllner, Zoltán Varga, Anikó Maráz
The presence of normal tissues in the irradiated volume limits dose escalation during pelvic radiotherapy (RT) for prostate cancer. Supine and prone positions on a belly board were compared by analyzing the exposure of organs at risk (OARs) using intensity modulated RT (IMRT). The prospective trial included 55 high risk, localized or locally advanced prostate cancer patients, receiving definitive image-guided RT. Computed tomography scanning for irradiation planning was carried out in both positions. Gross tumor volume, clinical and planning target volumes (PTV) and OARs were delineated, defining subprostatic and periprostatic rectal subsegments...
June 7, 2018: Pathology Oncology Research: POR
Federica Franchino, Roberta Rudà, Riccardo Soffietti
Advances in chemotherapy and targeted therapies have improved survival in cancer patients with an increase of the incidence of newly diagnosed brain metastases (BMs). Intracranial metastases are symptomatic in 60-70% of patients. Magnetic resonance imaging (MRI) with gadolinium is more sensitive than computed tomography and advanced neuroimaging techniques have been increasingly used in the detection, treatment planning, and follow-up of BM. Apart from the morphological analysis, the most effective tool for characterizing BM is immunohistochemistry...
2018: Frontiers in Oncology
John V Hegde, Minsong Cao, Victoria Y Yu, Amar U Kishan, Narek Shaverdian, James Lamb, Michael L Steinberg
The accurate delivery of stereotactic body radiotherapy (SBRT) for definitive prostate cancer treatment is aided by intrafraction image guidance. The common methods for intrafraction imaging require the invasive placement of fiducial markers or electromagnetic transponders. Recently, a magnetic resonance imaging (MRI)-guided tri-cobalt-60 head radiotherapy system has become available for treatment, which can utilize real-time cine MRI to non-invasively track prostate motion. We report on a clinical vignette using this technique to deliver SBRT for the definitive treatment of intermediate-risk prostate cancer...
April 6, 2018: Curēus
Katsumi Hirose, Mariko Sato, Yoshiomi Hatayama, Hideo Kawaguchi, Fumio Komai, Makoto Sohma, Hideki Obara, Masashi Suzuki, Mitsuki Tanaka, Ichitaro Fujioka, Koji Ichise, Yoshihiro Takai, Masahiko Aoki
BACKGROUND: The purpose of this study was to evaluate the impact of markerless on-board kilovoltage (kV) cone-beam computed tomography (CBCT)-based positioning uncertainty on determination of the planning target volume (PTV) margin by comparison with kV on-board imaging (OBI) with gold fiducial markers (FMs), and to validate a methodology for the evaluation of PTV margins for markerless kV-CBCT in prostate image-guided radiotherapy (IGRT). METHODS: A total of 1177 pre- and 1177 post-treatment kV-OBI and 1177 pre- and 206 post-treatment kV-CBCT images were analyzed in 25 patients who received prostate IGRT with daily localization by implanted FMs...
June 7, 2018: Radiation Oncology
Frank Lagerwaard, Omar Bohoudi, Shyama Tetar, Marjan A Admiraal, Tezontl S Rosario, Anna Bruynzeel
Magnetic resonance-guided radiation therapy (MRgRT) not only allows for superior soft-tissue setup and online MR-guidance during delivery but also for inter-fractional plan re-optimization or adaptation. This plan adaptation involves repeat MR imaging, organs at risk (OARs) re-contouring, plan prediction (i.e., recalculating the baseline plan on the anatomy of that moment), plan re-optimization, and plan quality assurance. In contrast, intrafractional plan adaptation cannot be simply performed by pausing delivery at any given moment, adjusting contours, and re-optimization because of the complex and composite nature of deformable dose accumulation...
April 5, 2018: Curēus
Kyle R Padgett, Garrett N Simpson, Ricardo Llorente, Michael A Samuels, Nesrin Dogan
Online adaptive radiotherapy (ART) with frequent imaging has the potential to improve dosimetric accuracy by accounting for anatomical and functional changes during the course of radiotherapy. Presented are three interesting cases that provide an assessment of online adaptive magnetic resonance-guided radiotherapy (MRgRT) for lung stereotactic body radiotherapy (SBRT). The study includes three lung SBRT cases, treated on an MRgRT system where MR images were acquired for planning and prior to each treatment fraction...
April 4, 2018: Curēus
Kathryn Mittauer, Bhudatt Paliwal, Patrick Hill, John E Bayouth, Mark W Geurts, Andrew M Baschnagel, Kristin A Bradley, Paul M Harari, Stephen Rosenberg, Jeffrey V Brower, Andrzej P Wojcieszynski, Craig Hullett, R A Bayliss, Zacariah E Labby, Michael F Bassetti
Magnetic resonance-guided radiation therapy (MRgRT) offers advantages for image guidance for radiotherapy treatments as compared to conventional computed tomography (CT)-based modalities. The superior soft tissue contrast of magnetic resonance (MR) enables an improved visualization of the gross tumor and adjacent normal tissues in the treatment of abdominal and thoracic malignancies. Online adaptive capabilities, coupled with advanced motion management of real-time tracking of the tumor, directly allow for high-precision inter-/intrafraction localization...
April 4, 2018: Curēus
Joshua N Freedman, David J Collins, Oliver J Gurney-Champion, Jamie R McClelland, Simeon Nill, Uwe Oelfke, Martin O Leach, Andreas Wetscherek
BACKGROUND AND PURPOSE: The superior soft-tissue contrast of 4D-T2w MRI motivates its use for delineation in radiotherapy treatment planning. We address current limitations of slice-selective implementations, including thick slices and artefacts originating from data incompleteness and variable breathing. MATERIALS AND METHODS: A method was developed to calculate midposition and 4D-T2w images of the whole thorax from continuously acquired axial and sagittal 2D-T2w MRI (1...
June 2, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Matteo Maspero, Peter R Seevinck, Nicole J W Willems, Gonda G Sikkes, Geja J de Kogel, Hans C J de Boer, Jochem R N van der Voort van Zyp, Cornelis A T van den Berg
BACKGROUND: The use of intraprostatic gold fiducial markers (FMs) ensures highly accurate and precise image-guided radiation therapy for patients diagnosed with prostate cancer thanks to the ease of localising FMs on photon-based imaging, like Computed Tomography (CT) images. Recently, Magnetic Resonance (MR)-only radiotherapy has been proposed to simplify the workflow and reduce possible systematic uncertainties. A critical, determining factor in the accuracy of such an MR-only simulation will be accurate FM localisation using solely MR images...
June 5, 2018: Radiation Oncology
Olga Hamming-Vrieze, Arash Navran, Abrahim Al-Mamgani, Wouter V Vogel
INTRODUCTION: In recent years, the possibility of adapting radiotherapy to changes in biological tissue parameters has emerged. It is hypothesized that early identification of radio-resistant parts of the tumor during treatment provides the possibility to adjust the radiotherapy plan to improve outcome. The aim of this systematic literature review was to evaluate the current state of the art of biological PET-guided adaptive radiotherapy, focusing on dose escalation to radio-resistant tumor...
June 4, 2018: Quarterly Journal of Nuclear Medicine and Molecular Imaging
Willem Grootjans, Lioe-Fee de Geus-Oei, Johan Bussink
With a worldwide annual incidence of 1.8 million cases, lung cancer is the most diagnosed form of cancer in men and the second most diagnosed form of cancer in women. Histologically, 80-85% of all lung cancers can be categorized as non-small cell lung cancer (NSCLC). For patients with locally advanced NSCLC, standard of care is fractionated radiotherapy combined with chemotherapy. With the aim of improving clinical outcome of patients with locally advanced NSCLC, combined and intensified treatment approaches are increasingly being used...
June 4, 2018: Quarterly Journal of Nuclear Medicine and Molecular Imaging
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