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Optimization of Field Design in the Treatment of Rectal Cancer with Intensity Modulated Proton Beam Radiation Therapy: How Many Fields Are Needed to Account for Rectal Distension Uncertainty?

Adv Radiat Oncol 2021 Sep-Oct;6(5):100749. Epub 2021 Jul 4.

Beaumont Proton Therapy Center, Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.

Purpose: Preoperative chemoradiation represents the standard of care in patients with locally advanced rectal cancer. Robustness is often compromised in the setting of proton beam therapy owing to the sensitivity of proton particles to tissue heterogeneity, such as with intestinal gas. The ideal beam arrangement to mitigate the anatomic uncertainty caused by intestinal gas is not well defined. Read More

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Measuring Faculty Effort: A Quantitative Approach That Aligns Personal and Institutional Goals in Pathology at Yale.

Acad Pathol 2021 Jan-Dec;8:23742895211047985. Epub 2021 Oct 7.

Department of Pathology, Yale School of Medicine, New Haven, CT, USA.

US medical schools increasingly seek ways to reduce costs and improve productivity. One aspect of this effort has been the development of performance-based incentives for individual faculty. A myriad of such plans exist. Read More

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October 2021

Biologically Targeted Radiation Therapy: Incorporating Patient-Specific Hypoxia Data Derived from Quantitative Magnetic Resonance Imaging.

Cancers (Basel) 2021 Sep 29;13(19). Epub 2021 Sep 29.

School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA 6009, Australia.

Purpose: Hypoxia has been linked to radioresistance. Strategies to safely dose escalate dominant intraprostatic lesions have shown promising results, but further dose escalation to overcome the effects of hypoxia require a novel approach to constrain the dose in normal tissue.to safe levels. Read More

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September 2021

Biological Impact of Target Fragments on Proton Treatment Plans: An Analysis Based on the Current Cross-Section Data and a Full Mixed Field Approach.

Cancers (Basel) 2021 Sep 24;13(19). Epub 2021 Sep 24.

Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics, (INFN), 38123 Trento, Italy.

Clinical routine in proton therapy currently neglects the radiobiological impact of nuclear target fragments generated by proton beams. This is partially due to the difficult characterization of the irradiation field. The detection of low energetic fragments, secondary protons and fragments, is in fact challenging due to their very short range. Read More

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September 2021

Dosimetric evaluation of different planning techniques based on flattening filter-free beams for central and peripheral lung stereotactic body radiotherapy.

Biomed Phys Eng Express 2021 Oct 12. Epub 2021 Oct 12.

Department of Radiotherapy, Government Medical College Patiala, Sangrur Road, Patiala, Punjab, 147001, INDIA.

This study aimed to dosimetrically compare and evaluate the flattening filter-free (FFF) photon beam-based three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT) for lungstereotactic body radiotherapy (SBRT). RANDO phantom computed tomography (CT) images were used for treatment planning. Gross tumor volumes (GTVs) were delineated in the central and peripheral lung locations. Read More

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October 2021

The Capabilities and Characteristics of Helical Tomotherapy and Co-Planar Dual Arcs Volumetric-Modulated arc Therapy Associated with Hippocampal Sparing During Prophylactic Cranial Irradiation.

Technol Cancer Res Treat 2021 Jan-Dec;20:15330338211043975

Shandong Cancer Hospital and Institute, 71107Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.

To investigate the features of helical tomotherapy and co-planar dual Arcs volumetric-modulated arc therapy during prophylactic cranial irradiation associated with bilateral hippocampal tissue sparing. Helical tomotherapy and co-planar dual arcs volumetric-modulated arc therapy treatment plans were generated with a dose of 30 Gy/10 fractions in 16 patients treated with prophylactic cranial irradiation. The dose to the bilateral hippocampal tissues, organs at risk, and planning target volume were determined when the average dose of bilateral hippocampal tissues was reduced by approximately 4 Gy as an observation point. Read More

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October 2021

Investigate the Dosimetric and Potential Clinical Benefits Utilizing Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost Technique for Locally Advanced Pancreatic Cancer: A Comparison Between Photon and Proton Beam Therapy.

Front Oncol 2021 22;11:747532. Epub 2021 Sep 22.

Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, United States.

Purpose: To investigate the potential clinical benefits of using stereotactic body radiation therapy (SBRT) with simultaneous integrated boost (SIB) technique for locally advanced pancreatic cancer (LAPC) among different treatment modalities and planning strategies, including photon and proton.

Method: A total of 19 patients were retrospectively selected in this study: 13 cases with the tumor located in the head of the pancreas and 6 cases with the tumor in the body of the pancreas. SBRT-SIB plans were generated using volumetric modulated arc therapy (VMAT), two-field Intensity Modulated Proton Therapy (IMPT), and three-field IMPT. Read More

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September 2021

Is there a volume threshold of brain metastases for Linac-based stereotactic radiotherapy?

J Radiosurg SBRT 2021 ;7(4):309-319

Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.

Purpose: To investigate whether there is a volume threshold in target volume of brain metastases below which a small cone size and sharp penumbra in Gamma Knife (GK) may provide improved plan quality when compared to Volumetric Modulated Arc Therapy (VMAT)-based stereotactic radiosurgery (SRS).

Methods: For patients treated on GK SRS for brain metastases in 2018-2019 in our institution, 121 patients with two and three targets were identified. Twenty-six patients with two or three brain metastases (total of 76 lesions) were selected for this study. Read More

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January 2021

Use of GammaPlan convolution algorithm for dose calculation on CT and cone-beam CT images.

Radiat Oncol J 2021 Jun 16;39(2):129-138. Epub 2021 Jun 16.

Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia.

Purpose: The aim of this study was to assess the suitability of using cone-beam computed tomography images (CBCTs) produced in a Leksell Gamma Knife (LGK) Icon system to generate electron density information for the convolution algorithm in Leksell GammaPlan (LGP) Treatment Planning System (TPS).

Materials And Methods: A retrospective set of 30 LGK treatment plans generated for patients with multiple metastases was selected in this study. Both CBCTs and fan-beam CTs were used to provide electron density data for the convolution algorithm. Read More

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Comparison of non-coplanar optimization of static beams and arc trajectories for intensity-modulated treatments of meningioma cases.

Phys Eng Sci Med 2021 Oct 7. Epub 2021 Oct 7.

Medical Physics Department of the Portuguese Oncology Institute of Coimbra Francisco Gentil, EPE, Coimbra, Portugal.

Two methods for non-coplanar beam direction optimization, one for static beams and another for arc trajectories, were proposed for intracranial tumours. The results of the beam angle optimizations were compared with the beam directions used in the clinical plans. Ten meningioma cases already treated were selected for this retrospective planning study. Read More

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October 2021

Indications of IMRT, PRT and CIRT for HCC from comparisons of dosimetry and normal tissue complication possibility.

Strahlenther Onkol 2021 Oct 7. Epub 2021 Oct 7.

Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.

Purpose: To identify the indications for hepatocellular carcinoma (HCC) irradiated by intensity-modulated photon radiotherapy (IMRT), proton radiotherapy (PRT) or carbon-ion radiotherapy (CIRT) by comparing of dosimetric parameters and incidences of classic radiation-induced liver disease (RILD).

Methods: In all, 40 HCCs were divided into group A (tumors located > 1 cm away from gastrointestinal [GI] tract), and group B (tumors located < 1 cm away from GI tract). The prescribed curative doses were 60 Gy (relative biological effectiveness [RBE]) in 10 fractions for group A, and 67. Read More

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October 2021

Impact of respiratory motion in dosimetric and clinical advantages for adjuvant left-sided breast radiotherapy.

J Radiat Res 2021 Oct 6. Epub 2021 Oct 6.

Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan.

We investigated the organ-sparing effect of the deep inspiration breath hold (DIBH) technique among different levels of lung expansion for left-side breast radiotherapy. This retrospective study enrolled 30 patients who received adjuvant left breast radiotherapy after breast-conserving surgery (BCS). Simulation scans of both DIBH and deep breathing four-dimensional computed tomography (4DCT) were acquired, and three treatment plans were generated for each patient. Read More

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October 2021

Novel Clinically Weight-Optimized Dynamic Conformal Arcs (WO-DCA) for Liver SBRT: A Comparison with Volumetric Modulated Arc Therapy (VMAT).

Ther Clin Risk Manag 2021 28;17:1053-1064. Epub 2021 Sep 28.

Koc University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey.

Purpose: To evaluate the feasibility of shortening the duration of liver stereotactic radiotherapy (SBRT) without jeopardizing dosimetry or conformity by utilizing weight-optimized dynamic conformal arcs (WO-DCA) as opposed to volumetric modulated arc therapy (VMAT) for tumors away from critical structures.

Methods: Nineteen patients with liver metastasis were included, previously treated with 50 Gy in 4 fractions with VMAT technique using two partial coplanar arcs of 6 MV beams delivered in high-definition multi-leaf collimator (HD-MLC). Two coplanar partial WO-DCA were generated on Pinnacle treatment planning system (TPS) for each patient; and MLC aperture around the planning target volume (PTV) was automatically generated at different margins for both arcs and maintained dynamically around the target during arc rotation. Read More

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September 2021

Illness and injury among Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles: prevailing high illness burden on the road from 2012 to 2020.

Br J Sports Med 2021 Oct 4. Epub 2021 Oct 4.

Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.

Objective: To describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types.

Methods: We monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention. Read More

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October 2021

Deformation trajectory prediction using a neural network trained on finite element data - application to library of CTVs creation for cervical cancer.

Phys Med Biol 2021 Oct 4. Epub 2021 Oct 4.

Radiotherapy Department, Netherlands Cancer Institute, Amsterdam, Noord-Holland, NETHERLANDS.

Purpose: We propose a neural network for fast prediction of realistic, time-parametrized deformations between pairs of input segmentations. The proposed method was used to generate a library of planning CTVs for cervical cancer radiotherapy.

Methods: A 3D convolutional neural network (CNN) was introduced to predict a stationary velocity field (SVF) given the distance maps of the cervix CTV in empty and full bladder anatomy. Read More

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October 2021

Adaptive magnetic resonance-guided neurovascular-sparing radiotherapy for preservation of erectile function in prostate cancer patients.

Phys Imaging Radiat Oncol 2021 Oct 21;20:5-10. Epub 2021 Sep 21.

Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.

Background And Purpose: Erectile dysfunction is a common adverse effect of external beam radiation therapy for localized prostate cancer (PCa), likely as a result of damage to neural and vascular tissue. Magnetic resonance-guided online adaptive radiotherapy (MRgRT) enables high-resolution MR imaging and paves the way for neurovascular-sparing approaches, potentially lowering erectile dysfunction after radiotherapy for PCa. The aim of this study was to assess the planning feasibility of neurovascular-sparing MRgRT for localized PCa. Read More

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October 2021

An Investigation of Non-Coplanar Volumetric Modulated Radiation Therapy for Locally Advanced Unresectable Pancreatic Cancer Using a Trajectory Optimization Method.

Front Oncol 2021 17;11:717634. Epub 2021 Sep 17.

Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.

Purpose: This study was conducted in order to develop a trajectory optimization algorithm for non-coplanar volumetric modulated arc therapy (VMAT) and investigate the potential of organs at risk (OARs) sparing in locally advanced pancreatic cancer patients using non-coplanar VMAT.

Methods And Materials: Firstly, a cost map that represents the ray-OAR voxel intersections at each source position was generated using a ray-tracing algorithm. A graph search algorithm was then used to determine the least-cost path from the cost map. Read More

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September 2021

On dose cube pixel spacing pre-processing for features extraction stability in dosiomic studies.

Phys Med 2021 Sep 30;90:108-114. Epub 2021 Sep 30.

Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy.

Purpose: Dosiomics allows to parameterize regions of interest (ROIs) and to produce quantitative dose features encoding the spatial and statistical distribution of radiotherapy dose. The stability of dosiomics features extraction on dose cube pixel spacing variation has been investigated in this study.

Material And Methods: Based on 17 clinical delivered dose distributions (P), dataset has been generated considering all the possible combinations of four dose grid resolutions and two calculation algorithms. Read More

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September 2021

Isotoxic investigation of F-FDG PET/CT-guided dose escalation with intensity-modulated radiotherapy for LA-NSCLC.

Int J Radiat Biol 2021 Oct 1:1-24. Epub 2021 Oct 1.

Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

Purpose: This research compared differences of dosimetric and biological parameters between PET/CT-guided isotoxic SIB-IMRT plans and conventional radiotherapy plans for patients with LA-NSCLC, and it also evaluated the factors that affect dose escalation.

Materials And Methods: This study consisted of a retrospective cohort of thirty patients with IIIA-IIIB NSCLC. SIB-IMRT (Plan_iso) and conventional radiotherapy (Plan_primary) plans were generated using auto-planning. Read More

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October 2021

Novel tools and strategies for breaking schistosomiasis transmission: study protocol for an intervention study.

BMC Infect Dis 2021 Sep 30;21(1):1024. Epub 2021 Sep 30.

Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.

Background: Global elimination of schistosomiasis as a public health problem is set as target in the new World Health Organization's Neglected Tropical Diseases Roadmap for 2030. Due to a long history of interventions, the Zanzibar islands of Tanzania have reached this goal since 2017. However, challenges occur on the last mile towards interruption of transmission. Read More

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September 2021

Prostate specific membrane antigen positron emission tomography for lesion-directed high-dose-rate brachytherapy dose escalation.

Phys Imaging Radiat Oncol 2021 Jul 30;19:102-107. Epub 2021 Jul 30.

Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.

Background And Purpose: Prostate specific membrane antigen positron emission tomography imaging (PSMA-PET) has demonstrated potential for intra-prostatic lesion localization. We leveraged our existing database of co-registered PSMA-PET imaging with cross sectional digitized pathology to model dose coverage of histologically-defined prostate cancer when tailoring brachytherapy dose escalation based on PSMA-PET imaging.

Materials And Methods: Using a previously-developed automated approach, we created segmentation volumes delineating underlying dominant intraprostatic lesions for ten men with co-registered pathology-imaging datasets. Read More

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Dynamic stochastic deep learning approaches for predicting geometric changes in head and neck cancer.

Phys Med Biol 2021 Sep 29. Epub 2021 Sep 29.

Machine Learning, Moffitt Cancer Center, Tampa, Florida, UNITED STATES.

Modern radiotherapy stands to benefit from the ability to efficiently adapt plans during treatment in response to setup and geometric variations such as those caused by internal organ deformation or tumor shrinkage. A promising strategy is to develop a framework, which given an initial state defined by patient-attributes, can predict future states based on patterns from a well-defined patient population. Here, we investigate the feasibility of predicting patient anatomical changes, defined as a joint state of volume and daily setup changes, across a fractionated treatment schedule using two approaches. Read More

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September 2021

Dosimetric benefits of dynamic conformal arc therapy-combined with active breath-hold in lung stereotactic body radiotherapy.

Med Dosim 2021 Sep 25. Epub 2021 Sep 25.

Division of Radiation Oncology, Allegheny Health Network Cancer Institution, 320 E North Ave, Ground Floor NW wing, Pittsburgh, PA 15212 USA.

To test the hypothesis that dynamic conformal arc therapy (DCAT) in Monaco, compared with volumetric modulated arc therapy (VMAT), maintains plan quality with higher delivery efficiency for lung stereotactic body radiotherapy (SBRT) and to investigate dosimetric benefits of DCAT with active breath-hold (DCAT+ABH), compared with free-breathing (DCAT+FB) for varying tumor sizes and motions. Fifty DCAT plans were used for lung SBRT. Randomly selected 17 DCAT plans were evaluated with respect to the retrospectively generated volumetric modulated arc therapy (VMAT) plans. Read More

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September 2021

Double isocenter optimization with HD-MLC linear accelerator to treat extended fields in patients with head and neck cancers.

J BUON 2021 Jul-Aug;26(4):1571-1581

Koc University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey.

Purpose: For departments with a congested patient burden or with a limited number of eligible LINACs, we investigated whether LINACS dedicated for SRS-SBRT with limited field high-definition (HD) multi-leaf collimator (MLC) could help to carry this load, and utilized a double-isocenter (DI) optimization with a limited field size of HD-MLC to defeat the craniocaudal field size restriction to match treated plans in a wide-field MLC LINAC for head and neck cancer patients.

Methods: Fourteen patients with locally advanced head and neck cancers were included, previously treated with simultaneous integrated boost volumetric modulated arc treatment (VMAT) in 33 fractions of clinical target volumes (CTV) of 70Gy, 63Gy, and 57Gy, via single isocenter (SI) plans in Millennium MLC-120 of Varian Trilogy. The DI plans were generated on Pinnacle TPS to be delivered in HD 120 leaves MLC on Varian Truebeam. Read More

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September 2021

Fast generation of lung SBRT plans with a knowledge-based planning model on ring-mounted Halcyon Linac.

J Appl Clin Med Phys 2021 Sep 25. Epub 2021 Sep 25.

Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA.

Purpose: To demonstrate fast treatment planning feasibility of stereotactic body radiation therapy (SBRT) for centrally located lung tumors on Halcyon Linac via a previously validated knowledge-based planning (KBP) model to support offline adaptive radiotherapy.

Materials/methods: Twenty previously treated non-coplanar volumetric-modulated arc therapy (VMAT) lung SBRT plans (c-Truebeam) on SBRT-dedicated C-arm Truebeam Linac were selected. Patients received 50 Gy in five fractions. Read More

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September 2021

Optimization of collimator angles in dual-arc volumetric modulated arc therapy planning for whole-brain radiotherapy with hippocampus and inner ear sparing.

Sci Rep 2021 Sep 24;11(1):19035. Epub 2021 Sep 24.

Department of Radiation Oncology and Therapy, The First Hospital of Jilin University, Changchun, 130021, China.

To optimize the collimator angles in dual-arc volumetric modulated arc therapy (VMAT) plans for whole-brain radiotherapy with hippocampus and inner ear sparing (HIS-WBRT). Two sets of dual-arc VMAT plans were generated for 13 small-cell lung cancer patients: (1) The collimator angles of arcs 1 and 2 (θ/θ) were 350°/10°, 350°/30°, 350°/45°, 350°/60°, and 350°/80°, i.e. Read More

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September 2021

Assessment of HDR brachytherapy-replicating prostate radiotherapy planning for tomotherapy, cyberknife and VMAT.

Med Dosim 2021 Sep 19. Epub 2021 Sep 19.

Sir Charles Gairdner Hospital, Perth, Australia; 5D Clinics, Perth, Australia; University of Western Australia, Perth, Australia. Electronic address:

A dosimetric study was undertaken to assess the ability of Cyberknife (CK), Volumetric Modulated Arc Therapy (VMAT), and TomoTherapy (Tomo) to generate treatment plans that mimic the dosimetry of high dose-rate brachytherapy (HDR BT) for prostate cancer. The project aimed to assess the potential of using stereotactic body radiotherapy (SBRT) for boost treatment of high-risk prostate cancer patients where HDR BT in combination with conformal external beam radiotherapy (EBRT) is the standard of care. The datasets of 6 prostate patients previously treated with HDR BT were collated. Read More

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September 2021

New fractionations in breast cancer: a dosimetric study of 3D-CRT versus VMAT.

J Med Radiat Sci 2021 Sep 22. Epub 2021 Sep 22.

Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.

Introduction: Adjuvant radiation therapy (RT) following primary surgery in women affected by early breast cancer (EBC) plays a central role in reducing local recurrences and overall mortality. The FAST-FORWARD trial recently demonstrated that 1-week hypofractionated adjuvant RT is not inferior to the standard schedule in terms of local relapse, cosmetic outcomes and toxicity. The aim of this in silico study was to evaluate the dosimetric aspects of a 1-week RT course, administered through volumetric modulated arc therapy (VMAT), compared with traditional three-dimensional conformal radiation therapy (3D-CRT) with tangential fields. Read More

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September 2021

Dosimetric Comparison, Treatment Efficiency Estimation, and Biological Evaluation of Popular Stereotactic Radiosurgery Options in Treating Single Small Brain Metastasis.

Front Oncol 2021 5;11:716152. Epub 2021 Aug 5.

Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

Objectives: This study aimed to show the advantages of each stereotactic radiosurgery (SRS) treatment option for single small brain metastasis among Gamma Knife (GK), Cone-based VMAT (Cone-VMAT), and MLC-based CRT (MLC-CRT) plans.

Materials And Methods: GK, Cone-VMAT, and MLC-CRT SRS plans were retrospectively generated for 11 patients with single small brain metastasis whose volume of gross tumor volume (GTV) ranged from 0.18 to 0. Read More

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Treatment planning comparison between dynamic wave arc and volumetric modulated arc therapies for prostate-cancer treatment.

Med Dosim 2021 Sep 16. Epub 2021 Sep 16.

Hiroshima High-Precision Radiotherapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima 732-0057, Japan; Department of Radiation Oncology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.

The aim of this study was to compare the quality of dynamic wave arc (DWA) and coplanar volumetric modulated arc therapy (co-VMAT) plans for the treatment of localized prostate cancer. The planning target volume (PTV)-rectum, a section of the PTV comprising the PTV minus that of the rectum, received 78 Gy in 39 fractions as the mean dose to the PTV-rectum. The DWA and co-VMAT plans were generated for each patient using the RayStation treatment planning system for the Vero4DRT system. Read More

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September 2021