{"title":"全国 Wilms 肿瘤研究中放疗后期健康影响大型回顾性研究的剂量重建工作成果","authors":"","doi":"10.1016/j.ijrobp.2024.07.021","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose/Objective(s)</h3><div>As the survival rates of childhood cancer improve, it becomes increasingly important to study the impact of multi-modality therapies on long-term health. Radiotherapy has been implicated as a contributor to late toxicities such as second malignant neoplasms and cardiovascular disease; however, there are still significant gaps in knowledge. Indeed, survivors presenting with late health effects today were treated before the widespread availability of 3D imaging and radiotherapy planning. However, without 3D organ dosimetry, it is difficult to translate the knowledge gained from past treatments into the dose tolerance criteria needed for improving outcomes for patients treated today. The National Wilms Tumor Study (NWTS) provides a unique opportunity to bridge this gap. This paper describes the methods, workflow, and results of a multi-year effort to reconstruct radiotherapy organ doses for the NWTS cohort in support of late effects research.</div></div><div><h3>Materials/Methods</h3><div>We reconstructed 3D organ doses for 4716 pediatric patients in the NWTS cohort. As CT images were not available for the NWTS patients, computational phantoms were selected from a body-size dependent phantom library to use as surrogate anatomy. Each patient was matched to a phantom in the library based on gender, height, and weight at age of Wilms tumor diagnosis. A DICOM CT image set and structure file for the matched phantom was then imported into a treatment planning system (TPS) for reconstruction of the radiotherapy fields according to paper medical records. The radiotherapy planning was performed by an experienced medical physicist under the supervision of a radiation oncologist familiar with protocols used during the NWTS trials. As the accuracy of the TPS is limited in the out-of-field region, Monte Carlo radiation transport calculations were also performed to improve the organ dose estimates. All calculations were performed on the NIH high-performance computing cluster.</div></div><div><h3>Results</h3><div>The patients were treated with a variety of photon energies: 4 MV (23%), 6 MV (48%), 10 MV (3%), Co-60 (23%), and other (3%). The most common treatment fields were left and right-flank, abdomen, and chest. The Monte Carlo dose calculations took approximately ~100 CPU hours (wall clock time ~2 hours) for a typical patient, resulting in approximately 0.5 million CPU hours in total for the cohort. Mean organ dose and dose-volume metrics were computed for more than 100 organs or tissues.</div></div><div><h3>Conclusion</h3><div>This study represents the first time Monte Carlo methods have been directly applied on a large scale to reconstruct organs doses for an epidemiological cohort. The organ doses for the NWTS cohort will provide valuable information for developing dose tolerance criteria for mitigating radiotherapy toxicity.</div></div>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":null,"pages":null},"PeriodicalIF":6.4000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Results of a Dose Reconstruction Effort for a Large-Scale Retrospective Study on Late Health Effects Following Radiotherapy within the National Wilms Tumor Study\",\"authors\":\"\",\"doi\":\"10.1016/j.ijrobp.2024.07.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose/Objective(s)</h3><div>As the survival rates of childhood cancer improve, it becomes increasingly important to study the impact of multi-modality therapies on long-term health. Radiotherapy has been implicated as a contributor to late toxicities such as second malignant neoplasms and cardiovascular disease; however, there are still significant gaps in knowledge. Indeed, survivors presenting with late health effects today were treated before the widespread availability of 3D imaging and radiotherapy planning. However, without 3D organ dosimetry, it is difficult to translate the knowledge gained from past treatments into the dose tolerance criteria needed for improving outcomes for patients treated today. The National Wilms Tumor Study (NWTS) provides a unique opportunity to bridge this gap. This paper describes the methods, workflow, and results of a multi-year effort to reconstruct radiotherapy organ doses for the NWTS cohort in support of late effects research.</div></div><div><h3>Materials/Methods</h3><div>We reconstructed 3D organ doses for 4716 pediatric patients in the NWTS cohort. As CT images were not available for the NWTS patients, computational phantoms were selected from a body-size dependent phantom library to use as surrogate anatomy. Each patient was matched to a phantom in the library based on gender, height, and weight at age of Wilms tumor diagnosis. A DICOM CT image set and structure file for the matched phantom was then imported into a treatment planning system (TPS) for reconstruction of the radiotherapy fields according to paper medical records. The radiotherapy planning was performed by an experienced medical physicist under the supervision of a radiation oncologist familiar with protocols used during the NWTS trials. As the accuracy of the TPS is limited in the out-of-field region, Monte Carlo radiation transport calculations were also performed to improve the organ dose estimates. All calculations were performed on the NIH high-performance computing cluster.</div></div><div><h3>Results</h3><div>The patients were treated with a variety of photon energies: 4 MV (23%), 6 MV (48%), 10 MV (3%), Co-60 (23%), and other (3%). The most common treatment fields were left and right-flank, abdomen, and chest. The Monte Carlo dose calculations took approximately ~100 CPU hours (wall clock time ~2 hours) for a typical patient, resulting in approximately 0.5 million CPU hours in total for the cohort. Mean organ dose and dose-volume metrics were computed for more than 100 organs or tissues.</div></div><div><h3>Conclusion</h3><div>This study represents the first time Monte Carlo methods have been directly applied on a large scale to reconstruct organs doses for an epidemiological cohort. The organ doses for the NWTS cohort will provide valuable information for developing dose tolerance criteria for mitigating radiotherapy toxicity.</div></div>\",\"PeriodicalId\":14215,\"journal\":{\"name\":\"International Journal of Radiation Oncology Biology Physics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":6.4000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Radiation Oncology Biology Physics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0360301624007831\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Radiation Oncology Biology Physics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0360301624007831","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Results of a Dose Reconstruction Effort for a Large-Scale Retrospective Study on Late Health Effects Following Radiotherapy within the National Wilms Tumor Study
Purpose/Objective(s)
As the survival rates of childhood cancer improve, it becomes increasingly important to study the impact of multi-modality therapies on long-term health. Radiotherapy has been implicated as a contributor to late toxicities such as second malignant neoplasms and cardiovascular disease; however, there are still significant gaps in knowledge. Indeed, survivors presenting with late health effects today were treated before the widespread availability of 3D imaging and radiotherapy planning. However, without 3D organ dosimetry, it is difficult to translate the knowledge gained from past treatments into the dose tolerance criteria needed for improving outcomes for patients treated today. The National Wilms Tumor Study (NWTS) provides a unique opportunity to bridge this gap. This paper describes the methods, workflow, and results of a multi-year effort to reconstruct radiotherapy organ doses for the NWTS cohort in support of late effects research.
Materials/Methods
We reconstructed 3D organ doses for 4716 pediatric patients in the NWTS cohort. As CT images were not available for the NWTS patients, computational phantoms were selected from a body-size dependent phantom library to use as surrogate anatomy. Each patient was matched to a phantom in the library based on gender, height, and weight at age of Wilms tumor diagnosis. A DICOM CT image set and structure file for the matched phantom was then imported into a treatment planning system (TPS) for reconstruction of the radiotherapy fields according to paper medical records. The radiotherapy planning was performed by an experienced medical physicist under the supervision of a radiation oncologist familiar with protocols used during the NWTS trials. As the accuracy of the TPS is limited in the out-of-field region, Monte Carlo radiation transport calculations were also performed to improve the organ dose estimates. All calculations were performed on the NIH high-performance computing cluster.
Results
The patients were treated with a variety of photon energies: 4 MV (23%), 6 MV (48%), 10 MV (3%), Co-60 (23%), and other (3%). The most common treatment fields were left and right-flank, abdomen, and chest. The Monte Carlo dose calculations took approximately ~100 CPU hours (wall clock time ~2 hours) for a typical patient, resulting in approximately 0.5 million CPU hours in total for the cohort. Mean organ dose and dose-volume metrics were computed for more than 100 organs or tissues.
Conclusion
This study represents the first time Monte Carlo methods have been directly applied on a large scale to reconstruct organs doses for an epidemiological cohort. The organ doses for the NWTS cohort will provide valuable information for developing dose tolerance criteria for mitigating radiotherapy toxicity.
期刊介绍:
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.