Strahlentherapie und Onkologie最新文献

{"title":"Artificial intelligence for response prediction and personalisation in radiation oncology.","authors":"Alex Zwanenburg, Gareth Price, Steffen Löck","doi":"10.1007/s00066-024-02281-z","DOIUrl":"https://doi.org/10.1007/s00066-024-02281-z","url":null,"abstract":"<p><p>Artificial intelligence (AI) systems may personalise radiotherapy by assessing complex and multifaceted patient data and predicting tumour and normal tissue responses to radiotherapy. Here we describe three distinct generations of AI systems, namely personalised radiotherapy based on pretreatment data, response-driven radiotherapy and dynamically optimised radiotherapy. Finally, we discuss the main challenges in clinical translation of AI systems for radiotherapy personalisation.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of second malignancies following prostate cancer radiotherapy in the era of conformal radiotherapy: a statement of the Prostate Cancer Working Group of the German Society of Radiation Oncology (DEGRO).","authors":"C Zamboglou, D M Aebersold, C Albrecht, D Boehmer, U Ganswindt, N-S Schmidt-Hegemann, S Hoecht, T Hölscher, S A Koerber, A-C Mueller, P Niehoff, J C Peeken, M Pinkawa, B Polat, S K B Spohn, F Wolf, D Zips, T Wiegel","doi":"10.1007/s00066-024-02288-6","DOIUrl":"https://doi.org/10.1007/s00066-024-02288-6","url":null,"abstract":"<p><p>A significant number of prostate cancer patients are long-term survivors after primary definitive therapy, and the occurrence of late side effects, such as second primary cancers, has gained interest. The aim of this editorial is to discuss the most current evidence on second primary cancers based on six retrospective studies published in 2021-2024 using large data repositories not accounting for all possible confounding factors, such as smoking or pre-existing comorbidities. Overall, prostate cancer patients treated with curative radiotherapy have an increased risk (0.7-1%) of the development of second primary cancers compared to patients treated with surgery up to 25 years after treatment. However, current evidence suggests that the implementation of intensity modulated radiation therapy is not increasing the risk of second primary cancers compared to conformal 3D-planned radiotherapy. Furthermore, increasing evidence indicates that highly conformal radiotherapy techniques may not increase the probability of second primary cancers compared to radical prostatectomy. Consequently, future studies should consider the radiotherapy technique and other confounding factors to provide a more accurate estimation of the occurrence of second primary cancers.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the implementation of phased-array heating systems in Plan2Heat.","authors":"H P Kok, J Crezee","doi":"10.1007/s00066-024-02264-0","DOIUrl":"https://doi.org/10.1007/s00066-024-02264-0","url":null,"abstract":"<p><strong>Background: </strong>Hyperthermia treatment planning can be supportive to ensure treatment quality, provided reliable prediction of the heating characteristics (i.e., focus size and effects of phase-amplitude and frequency steering) of the device concerned is possible. This study validates the predictions made by the treatment planning system Plan2Heat for various clinically used phased-array systems.</p><p><strong>Methods: </strong>The evaluated heating systems were AMC-2, AMC-4/ALBA-4D (Med-Logix srl, Rome, Italy), BSD Sigma-30, and Sigma-60 (Pyrexar Medical, Salt Lake City, UT, USA). Plan2Heat was used for specific absorption rate (SAR) simulations in phantoms representing measurement set-ups reported in the literature. SAR profiles from published measurement data based on E‑field or temperature rise were used to compare the device-specific heating characteristics predicted by Plan2Heat.</p><p><strong>Results: </strong>Plan2Heat is able to predict the correct location and size of the SAR focus, as determined by phase-amplitude settings and operating frequency. Measured effects of phase-amplitude steering on focus shifts (i.e., local SAR minima or maxima) were also correctly reflected in treatment planning predictions. Deviations between measurements and simulations were typically < 10-20%, which is within the range of experimental uncertainty for such phased-array measurements.</p><p><strong>Conclusion: </strong>Plan2Heat is capable of adequately predicting the heating characteristics of the AMC‑2, AMC-4/ALBA-4D, BSD Sigma-30, and Sigma-60 phased-array systems routinely used in clinical hyperthermia.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence for treatment delivery: image-guided radiotherapy.","authors":"Moritz Rabe, Christopher Kurz, Adrian Thummerer, Guillaume Landry","doi":"10.1007/s00066-024-02277-9","DOIUrl":"https://doi.org/10.1007/s00066-024-02277-9","url":null,"abstract":"<p><p>Radiation therapy (RT) is a highly digitized field relying heavily on computational methods and, as such, has a high affinity for the automation potential afforded by modern artificial intelligence (AI). This is particularly relevant where imaging is concerned and is especially so during image-guided RT (IGRT). With the advent of online adaptive RT (ART) workflows at magnetic resonance (MR) linear accelerators (linacs) and at cone-beam computed tomography (CBCT) linacs, the need for automation is further increased. AI as applied to modern IGRT is thus one area of RT where we can expect important developments in the near future. In this review article, after outlining modern IGRT and online ART workflows, we cover the role of AI in CBCT and MRI correction for dose calculation, auto-segmentation on IGRT imaging, motion management, and response assessment based on in-room imaging.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of intraoperative brachytherapy as a salvage treatment for locally recurrent rectal cancer.","authors":"Raluca Stoian, Hannes P Neeff, Mark Gainey, Michael Kollefrath, Simon Kirste, Constantinos Zamboglou, Jan Philipp Harald Exner, Dimos Baltas, Stefan Fichtner Feigl, Anca-Ligia Grosu, Tanja Sprave","doi":"10.1007/s00066-024-02271-1","DOIUrl":"https://doi.org/10.1007/s00066-024-02271-1","url":null,"abstract":"<p><strong>Background: </strong>Locally advanced recurrent rectal cancer (RRC) requires a multimodal approach. Intraoperative high-dose-rate brachytherapy (HDR-BT) may reduce the risk of local recurrence. However, the optimal therapeutic regimen remains unclear. The aim of this retrospective monocentric study was to evaluate the toxicity of HDR-BT after resection of RRC.</p><p><strong>Methods: </strong>Between 2018 and 2022, 17 patients with RRC received resection and HDR-BT. HDR-BT was delivered alone or as an anticipated boost with a median dose of 13 Gy (range 10-13 Gy) using an ¹⁹²iridium microSelectron HDR remote afterloader (Elekta AB, Stockholm, Sweden). All participants were followed for assessment of acute and late adverse events using the Common Terminology Criteria for Adverse Events version 5.0 and the modified Late Effects in Normal Tissues criteria (subjective, objective, management, and analytic; LENT-SOMA) at 3‑ to 6‑month intervals.</p><p><strong>Results: </strong>A total of 17 patients were treated by HDR-BT with median dose of 13 Gy (range 10-13 Gy). Most patients (47%) had an RRC tumor stage of cT3‑4 N0. At the time of RRC diagnosis, 7 patients (41.2%) had visceral metastases (hepatic, pulmonary, or peritoneal) in the sense of oligometastatic disease. The median interval between primary tumor resection and diagnosis of RRC was 17 months (range 1-65 months). In addition to HDR-BT, 2 patients received long-course chemoradiotherapy (CRT; up to 50.4 Gy in 1.8-Gy fractions) and 2 patients received short-course CRT up to 36 Gy in 2‑Gy fractions. For concomitant CRT, all patients received 5‑fluorouracil (5-FU) or capecitabine. Median follow-up was 13 months (range 1-54). The most common acute grade 1-2 toxicities were pain in 7 patients (41.2%), wound healing disorder in 3 patients (17.6%), and lymphedema in 2 patients (11.8%). Chronic toxicities were similar: grade 1-2 pain in 7 patients (41.2%), wound healing disorder in 3 patients (17.6%), and incontinence in 2 patients (11.8%). No patient experienced a grade ≥3 event.</p><p><strong>Conclusion: </strong>Reirradiation using HDR-BT is well tolerated with low toxicity. An individualized multimodality approach using HDR-BT in the oligometastatic setting should be evaluated in prospective multi-institutional studies.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Principles of artificial intelligence in radiooncology.","authors":"Yixing Huang, Ahmed Gomaa, Daniel Höfler, Philipp Schubert, Udo Gaipl, Benjamin Frey, Rainer Fietkau, Christoph Bert, Florian Putz","doi":"10.1007/s00066-024-02272-0","DOIUrl":"https://doi.org/10.1007/s00066-024-02272-0","url":null,"abstract":"<p><strong>Purpose: </strong>In the rapidly expanding field of artificial intelligence (AI) there is a wealth of literature detailing the myriad applications of AI, particularly in the realm of deep learning. However, a review that elucidates the technical principles of deep learning as relevant to radiation oncology in an easily understandable manner is still notably lacking. This paper aims to fill this gap by providing a comprehensive guide to the principles of deep learning that is specifically tailored toward radiation oncology.</p><p><strong>Methods: </strong>In light of the extensive variety of AI methodologies, this review selectively concentrates on the specific domain of deep learning. It emphasizes the principal categories of deep learning models and delineates the methodologies for training these models effectively.</p><p><strong>Results: </strong>This review initially delineates the distinctions between AI and deep learning as well as between supervised and unsupervised learning. Subsequently, it elucidates the fundamental principles of major deep learning models, encompassing multilayer perceptrons (MLPs), convolutional neural networks (CNNs), recurrent neural networks (RNNs), transformers, generative adversarial networks (GANs), diffusion-based generative models, and reinforcement learning. For each category, it presents representative networks alongside their specific applications in radiation oncology. Moreover, the review outlines critical factors essential for training deep learning models, such as data preprocessing, loss functions, optimizers, and other pivotal training parameters including learning rate and batch size.</p><p><strong>Conclusion: </strong>This review provides a comprehensive overview of deep learning principles tailored toward radiation oncology. It aims to enhance the understanding of AI-based research and software applications, thereby bridging the gap between complex technological concepts and clinical practice in radiation oncology.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning for autosegmentation for radiotherapy treatment planning: State-of-the-art and novel perspectives.","authors":"Ayhan Can Erdur, Daniel Rusche, Daniel Scholz, Johannes Kiechle, Stefan Fischer, Óscar Llorián-Salvador, Josef A Buchner, Mai Q Nguyen, Lucas Etzel, Jonas Weidner, Marie-Christin Metz, Benedikt Wiestler, Julia Schnabel, Daniel Rueckert, Stephanie E Combs, Jan C Peeken","doi":"10.1007/s00066-024-02262-2","DOIUrl":"https://doi.org/10.1007/s00066-024-02262-2","url":null,"abstract":"<p><p>The rapid development of artificial intelligence (AI) has gained importance, with many tools already entering our daily lives. The medical field of radiation oncology is also subject to this development, with AI entering all steps of the patient journey. In this review article, we summarize contemporary AI techniques and explore the clinical applications of AI-based automated segmentation models in radiotherapy planning, focusing on delineation of organs at risk (OARs), the gross tumor volume (GTV), and the clinical target volume (CTV). Emphasizing the need for precise and individualized plans, we review various commercial and freeware segmentation tools and also state-of-the-art approaches. Through our own findings and based on the literature, we demonstrate improved efficiency and consistency as well as time savings in different clinical scenarios. Despite challenges in clinical implementation such as domain shifts, the potential benefits for personalized treatment planning are substantial. The integration of mathematical tumor growth models and AI-based tumor detection further enhances the possibilities for refining target volumes. As advancements continue, the prospect of one-stop-shop segmentation and radiotherapy planning represents an exciting frontier in radiotherapy, potentially enabling fast treatment with enhanced precision and individualization.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol-based CT-guided brachytherapy for patients with prostate cancer and previous rectal extirpation-a curative approach.","authors":"Philipp Schubert, Vratislav Strnad, Thomas Weißmann, Claudia Schweizer, Michael Lotter, Stephan Kreppner, Andre Karius, Rainer Fietkau, Ricarda Merten","doi":"10.1007/s00066-024-02266-y","DOIUrl":"https://doi.org/10.1007/s00066-024-02266-y","url":null,"abstract":"<p><strong>Objective: </strong>There are numerous curative treatment possibilities for prostate cancer. In patients who have undergone rectal extirpation for rectal cancer treatment, curative options are limited due to anatomic changes and previous irradiation of the pelvis. In this analysis, we validate the feasibility of CT-guided transperineal interstitial brachytherapy for this specific scenario.</p><p><strong>Patients and methods: </strong>We analyzed the treatment procedures and outcomes of 5 patients with metachronic nonmetastatic prostate cancer. Ultrasound-guided brachytherapy was not possible in any of the patients. Of these 5 patients, 3 were treated for prostate cancer using temporary brachytherapy with Ir-192 only, and 2 were treated with external-beam radiation therapy and temporary brachytherapy as a boost. CT-guided brachytherapy was performed in all patients. We analyzed the feasibility, efficacy, treatment-related toxicity, and quality of life (EORTC-30, IEFF, IPSS, and ICIQ questionnaires) of the treatments.</p><p><strong>Results: </strong>Median follow-up was 35 months. Two out of five patients received boost irradiation (HDR 2 × 9 Gy, PDR 30 Gy). Three out of five patients were treated with PDR brachytherapy in two sessions up to a total dose of 60 Gy. Dosimetric parameters were documented as median values as follows: V100 94.7% (94.5-98.4%), D2_bladder 64.3% (50.9-78.3%), D10_urethra 131.05% (123.2%-141.2%), and D30_urethra 122.45% (116.2%-129.5%). At the time of analysis, no biochemical recurrence had been documented. Furthermore, neither early nor late side effects exceeding CTCAE grade 2 were documented.</p><p><strong>Conclusion: </strong>CT-guided transperineal brachytherapy of the prostate in patients with previous rectal surgery and radiation therapy is safe and represents a possible curative treatment option. Brachytherapy can be considered for patients with metachronic prostate cancer in this specific scenario, albeit preferably in experienced high-volume centers.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Low-dose radiotherapy for greater trochanteric pain syndrome-a single-centre analysis.","authors":"Michal Staruch, Silvia Gomez, Susanne Rogers, Istvan Takacs, Thomas Kern, Sabine Adler, Dieter Cadosch, Oliver Riesterer","doi":"10.1007/s00066-024-02273-z","DOIUrl":"https://doi.org/10.1007/s00066-024-02273-z","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transrectal ultrasound for intraoperative interstitial needle guidance in cervical cancer brachytherapy.","authors":"J Knoth, A Sturdza, A Zaharie, V Dick, G Kronreif, N Nesvacil, J Widder, C Kirisits, M P Schmid","doi":"10.1007/s00066-024-02207-9","DOIUrl":"10.1007/s00066-024-02207-9","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to prospectively assess the visibility of interstitial needles on transrectal ultrasound (TRUS) in cervical cancer brachytherapy patients and evaluate its impact on implant and treatment plan quality.</p><p><strong>Material and methods: </strong>TRUS was utilized during and after applicator insertion, with each needle's visibility documented through axial images at the high-risk clinical target volume's largest diameter. Needle visibility on TRUS was scored from 0 (no visibility) to 3 (excellent discrimination, margins distinct). Quantitative assessment involved measuring the distance between tandem and each needle on TRUS and comparing it to respective magnetic resonance imaging (MRI) measurements. Expected treatment plan quality based on TRUS images was rated from 1 (meeting all planning objectives) to 4 (violation of High-risk clinical target volume (CTV_HR) and/or organ at risk (OAR) hard constraints) and compared to the final MRI-based plan.</p><p><strong>Results: </strong>Analysis included 23 patients with local FIGO stage IB2-IVA, comprising 41 applications with a total of 230 needles. A high visibility rate of 99.1% (228/230 needles) was observed, with a mean visibility score of 2.5 ± 0.7 for visible needles. The maximum and mean difference between MRI and TRUS measurements were 8 mm and -0.1 ± 1.6 mm, respectively, with > 3 mm discrepancies in 3.5% of needles. Expected treatment plan quality after TRUS assessment exactly aligned with the final MRI plan in 28 out of 41 applications with only minor deviations in all other cases.</p><p><strong>Conclusion: </strong>Real-time TRUS-guided interstitial needle placement yielded high-quality implants, thanks to excellent needle visibility during insertion. This supports the potential of TRUS-guided brachytherapy as a promising modality for gynecological indications.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"684-690"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11272749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}