Radiotherapy and Oncology最新文献

{"title":"Identifying paediatric patients at risk of severe hearing impairment after treatment for malignancies of the H&N/CNS with proton therapy","authors":"Simona Gaito ,&nbsp;Eunji Hwang ,&nbsp;David Thwaites ,&nbsp;Verity Ahern ,&nbsp;Ed Smith ,&nbsp;Gillian A. Whitfield ,&nbsp;Peter Sitch ,&nbsp;Anna France ,&nbsp;Marianne Aznar","doi":"10.1016/j.radonc.2024.110597","DOIUrl":"10.1016/j.radonc.2024.110597","url":null,"abstract":"<div><h3>Background and purpose</h3><div>A risk calculation model was presented in 2021 by Keilty et al. for determining the likelihood of severe hearing impairment (HI) for paediatric patients treated with photon radiation therapy. This study aimed to validate their risk-prediction model for our cohort of paediatric patients treated with proton therapy (PT) for malignancies of the head and neck (H&amp;N) or central nervous system (CNS).</div></div><div><h3>Materials and methods</h3><div>This was a single-institution study which extracted data on all patients aged ≤ 18 years treated with PT between Feb 2010 – Feb 2022 for malignancies of the H&amp;N/CNS. The factors required for input into the Keilty model were extracted: age at PT, time since end of PT, mean cochlea dose, and platinum chemotherapy doses. Validation was performed using the statistical software R v 4.3.1, which analysed event discrimination and model calibration.</div></div><div><h3>Results</h3><div>587 patients met the criteria. Validation of the model demonstrated excellent discriminative ability, with an “optimal” cut-off value of 16% at a specificity and sensitivity of 82%. However, model calibration was less satisfactory, indicating an overestimation of risk of severe hearing loss (HI) by the model as compared to clinically observed events in our cohort, possibly linked to differences in event scoring between the model developers and this study, and short follow-up time in this study.</div></div><div><h3>Conclusion</h3><div>The published (photon-based) model of Keilty et al. was validated in a PT context, demonstrating a high discriminative ability to determine patients at high risk versus low risk for severe HI. However the overall observed risk was lower than model predictions.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110597"},"PeriodicalIF":4.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ESTRO-EANO guideline on target delineation and radiotherapy for IDH-mutant WHO CNS grade 2 and 3 diffuse glioma","authors":"Brigitta G. Baumert ,&nbsp;Jaap P. M. Jaspers ,&nbsp;Vera C. Keil ,&nbsp;Norbert Galldiks ,&nbsp;Ewa Izycka-Swieszewska ,&nbsp;Beate Timmermann ,&nbsp;Anca L. Grosu ,&nbsp;Giuseppe Minniti ,&nbsp;Umberto Ricardi ,&nbsp;Frédéric Dhermain ,&nbsp;Damien C. Weber ,&nbsp;Martin van den Bent ,&nbsp;Roberta Rudà ,&nbsp;Maximilian Niyazi ,&nbsp;Sara Erridge","doi":"10.1016/j.radonc.2024.110594","DOIUrl":"10.1016/j.radonc.2024.110594","url":null,"abstract":"<div><h3>Purpose</h3><div>This guideline will discuss radiotherapeutic management of IDH-mutant grade 2 and grade 3 diffuse glioma, using the latest 2021 WHO (5th) classification of brain tumours focusing on: imaging modalities, tumour volume delineation, irradiation dose and fractionation.</div></div><div><h3>Methods</h3><div>The ESTRO Guidelines Committee, CNS subgroup, nominated 15 European experts who identified questions for this guideline. Four working groups were established addressing specific questions concerning imaging, target volume delineation, radiation techniques and fractionation. A literature search was performed, and available literature was discussed. A modified two-step Delphi process was used with majority voting resulted in a decision or highlighting areas of uncertainty.</div></div><div><h3>Results</h3><div>Key issues identified and discussed included imaging needed to define target definition, target delineation and the size of margins, and technical aspects of treatment including different planning techniques such as proton therapy.</div></div><div><h3>Conclusions</h3><div>The GTV should include any residual tumour volume after surgery, as well as the resection cavity. Enhancing lesions on T1 imaging should be included if they are indicative of residual tumour. In grade 2 tumours, T2/FLAIR abnormalities should be included in the GTV. In grade 3 tumours, T2/FLAIR abnormalities should also be included, except areas that are considered to be oedema which should be omitted from the GTV. A GTV to CTV expansion of 10 mm is recommended in grade 2 tumours and 15 mm in grade 3 tumours. A treatment dose of 50.4 Gy in 28 fractions is recommended in grade 2 tumours and 59.4 Gy in 33 fractions in grade 3 tumours. Radiation techniques with IMRT are the preferred approach.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110594"},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose calculation accuracy of a new high-performance ring-gantry CBCT imaging system for prostate and lung cancer patients","authors":"Nienke D. Sijtsema,&nbsp;Joan J. Penninkhof,&nbsp;Agustinus J.A.J. van de Schoot,&nbsp;Britt Kunnen,&nbsp;Judith H. Sluijter,&nbsp;Marjan van de Pol,&nbsp;Femke E. Froklage,&nbsp;Maarten L.P. Dirkx,&nbsp;Steven F. Petit","doi":"10.1016/j.radonc.2024.110596","DOIUrl":"10.1016/j.radonc.2024.110596","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The recently introduced high-performance CBCT imaging system called HyperSight offers improved Hounsfield units (HU) accuracy, a larger CBCT field-of-view and improved image quality compared to conventional ring gantry CBCT, possibly enabling treatment planning on CBCT imaging directly. In this study, we evaluated whether the dose calculation accuracy on HyperSight CBCT was sufficient for treatment planning in prostate and lung cancer patients.</div></div><div><h3>Materials and methods</h3><div>HyperSight CBCT was compared to planning CT (pCT) in terms of HU-to-mass density (MD) calibration curves. For twenty prostate patients and twenty lung patients, differences in DVH parameters, and 3D global gamma between dose distributions calculated on pCT and free breathing HyperSight CBCT were evaluated. For this purpose, HyperSight CBCT acquired at the first fraction was rigidly registered to the pCT, delineations from the CT were propagated and the dose was recalculated on the HyperSight CBCT.</div></div><div><h3>Results</h3><div>For each insert of the HU-to-MD calibration phantom, the HU values of HyperSight CBCT and pCT agreed within 35 HU. For prostate maximum deviations in PTV D_mean, V_95% and V_107% were 1.8 %, −1.1 % and &lt; 0.1 % respectively. For lung PTV V_95% was generally lower (median −1.1 %) and PTV V_107% was generally higher (median 1.1 %) on HyperSight CBCT due to breathing motion artifacts. The average (±SD) 2 %/2mm gamma pass rate was 98.7 %±1.2 % for prostate cancer patients and 96.2 %±2.1 % for lung cancer patients.</div></div><div><h3>Conclusion</h3><div>HyperSight CBCT enabled accurate dose calculation for prostate cancer patients, without implementation of a specific HyperSight CBCT-to-MD curve. For lung cancer patients, breathing motion hampered accurate dose calculations.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110596"},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose constraints in breast cancer radiotherapy. A critical review","authors":"Fiorenza De Rose ,&nbsp;Maria Carmen De Santis ,&nbsp;Sara Lucidi ,&nbsp;Riccardo Ray Colciago ,&nbsp;Lorenza Marino ,&nbsp;Francesca Cucciarelli ,&nbsp;Eliana La Rocca ,&nbsp;Francesca Di Pressa ,&nbsp;Frank Lohr ,&nbsp;Valentina Vanoni ,&nbsp;Bruno Meduri","doi":"10.1016/j.radonc.2024.110591","DOIUrl":"10.1016/j.radonc.2024.110591","url":null,"abstract":"<div><div>Radiotherapy plays an essential role in the treatment of breast cancer (BC). Recent advances in treatment technology and radiobiological knowledge have a major impact in BC patients with locoregional disease as the majority are now long-term survivors.</div><div>Over the last three decades, intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy (VMAT) and deep inspiration breath-hold (DIBH) techniques, together with the increasing adoption of moderately hypofractionated and ultra-hypofractionated treatment schedules as well as the possibility to offer partial breast radiotherapy to a well-defined patient subset have significantly changed radiotherapy for BC patients.</div><div>As dose-volume constraints (DVCs) have to be adapted to these new treatment paradigms we have reviewed available evidence-based data concerning dose-constraints for the main organs at risk (OARs) that apply to the treatment of whole breast/chest wall radiotherapy, whole breast/chest wall radiotherapy including regional nodal irradiation (RNI) and partial breast irradiation (PBI), for the most relevant fractionation schedules that have been introduced recently. This narrative review provides a comprehensive summary that may help to harmonize treatment planning strategies.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110591"},"PeriodicalIF":4.9,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variable-RBE-induced NTCP predictions for various side-effects following proton therapy for brain tumors – Identification of high-risk patients and risk mitigation","authors":"Martina Palkowitsch ,&nbsp;Lisa-Marie Kaufmann ,&nbsp;Fabian Hennings ,&nbsp;Stefan Menkel ,&nbsp;Christian Hahn ,&nbsp;Jona Bensberg ,&nbsp;Armin Lühr ,&nbsp;Annekatrin Seidlitz ,&nbsp;Esther G.C. Troost ,&nbsp;Mechthild Krause ,&nbsp;Steffen Löck","doi":"10.1016/j.radonc.2024.110590","DOIUrl":"10.1016/j.radonc.2024.110590","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Disregarding the increase of relative biological effectiveness (RBE) may raise the risk of acute and late adverse events after proton beam therapy (PBT). This study aims to explore the relationship between variable RBE (above 1.1)-induced normal tissue complication probabilities (NTCP) and patient-specific factors, identify patients at high risk of RBE-induced NTCP increase, and assess risk mitigation by incorporating RBE variability into treatment planning.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 105 primary brain tumor patients treated with PBT (RBE = 1.1). We calculated differences in estimated NTCP (ΔNTCP) using a variable RBE-weighted dose (D_RBE, Wedenberg model) and a constant RBE-weighted dose (D_RBE=1.1), across 16 NTCP models. These differences were correlated with patient-specific characteristics. Based on ΔNTCP, patients were classified as high risk (32 %) or low risk (68 %) for adverse events due to RBE-induced NTCP. This classification was compared with alternative classifications based on (a) relevant patient-specific characteristics, (b) D_RBE=1.1, and (c) the difference between D_RBE and D_RBE=1.1 (ΔD), assessing the balanced accuracy. The potential to reduce RBE-induced NTCP through track-end and linear energy transfer (LET) optimization was evaluated in six example patients.</div></div><div><h3>Results</h3><div>Using a variable RBE instead of a constant one resulted in NTCP increases (up to 32 percentage points). Variable-RBE-induced NTCP increases were strongly negatively correlated with the distance between the clinical target volume (CTV) and the organ at risk (OAR) for most side-effects, and positively correlated with CTV volume for certain side-effects. High increases were associated with (a) specific patient factors, particularly the proximity of the CTV to OARs, (b) D_RBE=1.1, and (c) ΔD, with a balanced accuracy of 0.88, 0.94, and 0.86, respectively. Optimization of track-ends and LET considerably reduced NTCP values, achieving a mean reduction of 31 % for optimized OARs.</div></div><div><h3>Conclusion</h3><div>The risk of variable-RBE-induced NTCP strongly depends on patient-specific factors and the considered side-effect. A small distance between the tumor and OARs notably increases the risk. Integrating biologically-guided objectives into treatment planning can effectively mitigate the risk.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110590"},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel lineage-tracing tool reveals that hypoxic tumor cells drive tumor relapse after radiotherapy","authors":"Apostolos Menegakis ,&nbsp;Claire Vennin ,&nbsp;Jonathan Ient ,&nbsp;Arjan J. Groot ,&nbsp;Lenno Krenning ,&nbsp;Rob Klompmaker ,&nbsp;Anoek Friskes ,&nbsp;Mila Ilic ,&nbsp;Ala Yaromina ,&nbsp;Rolf Harkes ,&nbsp;Bram van den Broek ,&nbsp;Jan Jakob Sonke ,&nbsp;Monique De Jong ,&nbsp;Jolanda Piepers ,&nbsp;Jacco van Rheenen ,&nbsp;Marc A. Vooijs ,&nbsp;René H. Medema","doi":"10.1016/j.radonc.2024.110592","DOIUrl":"10.1016/j.radonc.2024.110592","url":null,"abstract":"<div><h3>Purpose</h3><div>Tumor hypoxia imposes a main obstacle to the efficacy of anti-cancer therapy. Understanding the cellular dynamics of individual hypoxic cells before, during and post-treatment has been hampered by the technical inability to identify and trace these cells over time.</div></div><div><h3>Methods and materials</h3><div>Here, we present a novel lineage-tracing reporter for hypoxic cells based on the conditional expression of a HIF1a-CreER^T2-UnaG biosensor that can visualize hypoxic cells in a time-dependent manner and trace the fate of hypoxic cells over time. We combine this system with multiphoton microscopy, flow cytometry, and immunofluorescence to characterize the role of hypoxic cells in tumor relapse after irradiation in H1299 tumor spheroids and <em>in vivo</em> xenografts.</div></div><div><h3>Results</h3><div>We validate the reporter in monolayer cultures and we show that tagged cells colocalize in spheroids and human tumor xenografts with the hypoxic marker pimonidazole. We found that irradiation of H1299-HIFcreUnaG spheroids leads to preferential outgrowth of cells from the hypoxic core. Similarly, in xenografts tumors, although initially UnaG-positive-cells coincide with pimonidazole-positive tumor areas and they are merely quiescent, upon irradiation UnaG-positive cells enrich in regrowing tumors and are mainly proliferative.</div></div><div><h3>Conclusions</h3><div>Collectively, our data provide clear evidence that the hypoxic cells drive tumor relapse after irradiation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110592"},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient reported fatigue after proton therapy for malignant brain tumours – Is there a relation between radiation dose and brain structures?","authors":"Ingrid Kristensen ,&nbsp;Ulrica Langegård ,&nbsp;Thomas Björk-Eriksson ,&nbsp;Malin Blomstrand ,&nbsp;Patrik Brodin ,&nbsp;Per Fransson ,&nbsp;Per Munck af Rosenschöld ,&nbsp;Fredrik Nordström ,&nbsp;Emma Olsson-Nevo ,&nbsp;Katarina Sjövall ,&nbsp;Karin Ahlberg","doi":"10.1016/j.radonc.2024.110582","DOIUrl":"10.1016/j.radonc.2024.110582","url":null,"abstract":"<div><h3>Background</h3><div>Fatigue may significantly effect everyday- and working life for radiotherapy patients. Some studies indicate a correlation between radiation dose and irradiated volume of the brain and the presence of fatigue. Our hypothesis was that patient reported outcome measures (PROMs) can improve our understanding of the patients’ symptoms following proton beam therapy (PBT) and optimize PBT for future patients.</div></div><div><h3>Methods</h3><div>This study included 167 adult patients (&gt;18 years) who received PBT for malignant brain tumours. Data on dose metrics to intra-cranial structures was obtained from PBT treatment plans. To explore fatigue and health related quality of life (HRQoL); Multidimensional Fatigue Inventory (MFI-20) and EORTC QLQ-C30 was used at 6-, 12-, 24- and 36 months post PBT. The correlation between fatigue and dosimetry was explored using Spearman’s signed rank test.</div></div><div><h3>Results</h3><div>No severe fatigue was recorded during the 36 months follow-up. Correlations between higher radiation dose and worsened fatigue scores were generally weak (rho &lt; 0.3). At 12 months post PBT, higher mean dose to the brain, brainstem, hippocampi and pituitary was correlated to worsened MFI Physical Fatigue. Further, Reduced Motivation according to MFI was correlated to higher radiation dose to the brainstem and the pituitary gland. At 36 months follow-up post-PBT, both Reduced Activity and Reduced motivation according to MFI were correlated to higher radiation dose to the brain, brainstem and hippocampi.</div></div><div><h3>Conclusion</h3><div>Proton beam therapy are well tolerated, with similar degree of fatigue pre- and post PBT. Achieving further reduction in mean brain dose appears beneficial.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110582"},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of photobiomodulation therapy for acute radiation dermatitis in patients with cancer: A systematic review and meta‑analysis of real-world evidence","authors":"Ying-Tong Lin ,&nbsp;Kuang-Mou Tung ,&nbsp;Jeng-Fong Chiou ,&nbsp;Yen-Chao Chen ,&nbsp;Wen-Hsuan Hou","doi":"10.1016/j.radonc.2024.110589","DOIUrl":"10.1016/j.radonc.2024.110589","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the effectiveness of photobiomodulation therapy (PBMT) for acute radiation dermatitis (ARD) in patients with cancer.</div></div><div><h3>Materials and methods</h3><div>PubMed, Embase, Cochrane Library, and CINAHL were searched for articles published between database inception until July 2024. Randomized controlled trials (RCTs) and non-RCTs examining the effects of PBMT against ARD in patients with cancer were included for analysis. A random-effects model was used to conduct <em>meta</em>-analyses and sensitivity analyses. Subgroup analyses were conducted for cancer types and PBMT goals (prevention or treatment of ARD) with stratification for different grades of ARD.</div></div><div><h3>Results</h3><div>Eight studies (five RCTs and three non-RCTs) were included in this <em>meta</em>-analysis. Compared with the control group, the PBMT group exhibited significantly lower ARD incidence at grades 2 and 3 (risk difference =  − 0.36, 95 % confidence interval =  − 0.53 to − 0.19, <em>I</em>² = 85 %, <em>P</em> = &lt; 0.00001). Subgroup analyses revealed that, compared with the control group, PBMT had a significant effect on both breast cancer and head and neck cancer. In addition, PBMT significantly reduced grades 2 and 3 ARD incidence in the PBMT group for both prevention and treatment subgroups.</div></div><div><h3>Conclusion</h3><div>PBMT may have beneficial effects on the prevention and treatment of higher-grade ARD in patients with breast cancer and head and neck cancer. Nevertheless, the studies included in this <em>meta</em>-analysis exhibited high heterogeneity. Therefore, the results must be interpreted with caution.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110589"},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consistency in reirradiation scenarios: Terminology, tissue recovery in calculations, units and reporting","authors":"Nick West ,&nbsp;Elizabeth Covington ,&nbsp;Eliana Vasquez Osorio ,&nbsp;Joep Stroom ,&nbsp;Michael Duchateau ,&nbsp;Madalyne Day ,&nbsp;Nick Hardcastle ,&nbsp;Myriam Ayadi ,&nbsp;Andrew Jackson ,&nbsp;Heidi S. Rønde ,&nbsp;Chuck Mayo ,&nbsp;Ane Appelt","doi":"10.1016/j.radonc.2024.110587","DOIUrl":"10.1016/j.radonc.2024.110587","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110587"},"PeriodicalIF":4.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving accurate prostate auto-segmentation on CT in the absence of MR imaging","authors":"Jingwei Duan ,&nbsp;Riley C. Tegtmeier ,&nbsp;Carlos E. Vargas ,&nbsp;Nathan Y. Yu ,&nbsp;Brady S. Laughlin ,&nbsp;Jean-Claude M. Rwigema ,&nbsp;Justin D. Anderson ,&nbsp;Libing Zhu ,&nbsp;Quan Chen ,&nbsp;Yi Rong","doi":"10.1016/j.radonc.2024.110588","DOIUrl":"10.1016/j.radonc.2024.110588","url":null,"abstract":"<div><h3>Background</h3><div>Magnetic resonance imaging (MRI) is considered the gold standard for prostate segmentation. Computed tomography (CT)-based segmentation is prone to observer bias, potentially overestimating the prostate volume by ∼ 30 % compared to MRI. However, MRI accessibility is challenging for patients with contraindications or in rural areas globally with limited clinical resources.</div></div><div><h3>Purpose</h3><div>This study investigates the possibility of achieving MRI-level prostate auto-segmentation accuracy using CT-only input via a deep learning (DL) model trained with CT-MRI registered segmentation.</div></div><div><h3>Methods and Materials</h3><div>A cohort of 111 definitive prostate radiotherapy patients with both CT and MRI images was retrospectively grouped into training (n = 37) and validation (n = 20) (where reference contours were derived from CT-MRI registration), and testing (n = 54) sets. Two commercial DL models were benchmarked against the reference contours in the training and validation sets. A custom DL model was incrementally retrained using the training dataset, quantitatively evaluated on the validation dataset, and qualitatively assessed by two different physician groups on the validation and testing datasets. A contour quality assurance (QA) model, established from the proposed model on the validation dataset, was applied to the test group to identify potential errors, confirmed by human visual inspection.</div></div><div><h3>Results</h3><div>Two commercial models exhibited large deviations in the prostate apex with CT-only input (median: 0.77/0.78 for Dice similarity coefficient (DSC), and 0.80 cm/0.83 cm for 95 % directed Hausdorff Distance (HD95), respectively). The proposed model demonstrated superior geometric similarity compared to commercial models, particularly in the apex region, with improvements of 0.05/0.17 cm and 0.06/0.25 cm in median DSC/HD95, respectively. Physician evaluation on MRI-CT registration data rated 69 %-78 % of the proposed model’s contours as clinically acceptable without modifications. Additionally, 73 % of cases flagged by the contour quality assurance (QA) model were confirmed via visual inspection.</div></div><div><h3>Conclusions</h3><div>The proposed incremental learning strategy based on CT-MRI registration information enhances prostate segmentation accuracy when MRI availability is limited clinically.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110588"},"PeriodicalIF":4.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}