Cone-beam CT-guided radiotherapy in the management of lung cancer

Elsayad, Khaled; Kříž, Jan; Reinartz, Gabriele; Scobioala, Sergiu; Ernst, Iris; Haverkamp, Uwe; Eich, Hans Theodor

doi:10.1007/s00066-015-0927-y

Cited by 32 publications

(31 citation statements)

References 32 publications

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“…tumour shrinkage, atelectasis or pleural effusion), or displacements of anatomical structures (e.g. a baseline shift of the tumour or a shift of the mediastinal structures) needing adaptations occur in approximately 12-27% of the patients during fractionated radiotherapy [1][2][3][4][5][6][7]. As a result, the delivered dose to the tumour or organs at risk may deviate from the planned dose and become unacceptable [4,8].…”

Section: Introductionmentioning

confidence: 99%

Automatic selection of lung cancer patients for adaptive radiotherapy using cone-beam CT imaging

Bosch

Öllers

Reymen

et al. 2017

Physics and Imaging in Radiation Oncology

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Background and purpose: Anatomical changes in non-small cell lung cancer (NSCLC) patients may lead to unacceptable treatment results, requiring adaptive radiotherapy (ART). The method proposed in this study describes the proof-of-principle to automatically select patients eligible for ART. Materials and methods: A method was developed flagging patients potentially requiring replanning using changes in density information between the planning CT and cone-beam CT (CBCT) scan. Potential candidates were defined based on anatomical changes in the primary tumour, mediastinum and a region including the lungs. In total, CBCTs of 70 NSCLC patients were retrospectively scored by two independent experts for the need of replanning using the clinical guidelines. Expert evaluation was used as benchmark for the automatic method and accuracy was quantified using a leave-one-out cross-validation strategy. Results: The automatic method correctly selected 79%, 71%, and 89% of the pre-defined candidates based on anatomical change in the tumour, mediastinum and lungs, respectively. The false positive rate was 27%, 9%, and 19% for these regions, respectively. If a single criterion ('flag') per patient is sufficient for replanning, the overall sensitivity was 89% with a false positive rate of 34%. Most common reasons for false positives were changes in breathing pattern or anatomical shifts outside the evaluated region. Excluding these reasons, the false positive rate dropped to 21% and the accuracy was almost similar to expert evaluation: overall sensitivity of approx. 95% with a false positive rate below 19%. Conclusion: Our method based on daily CBCT allows automatic selection of patients that should be investigated for treatment adaptation.

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Section: Introductionmentioning

confidence: 99%

Automatic selection of lung cancer patients for adaptive radiotherapy using cone-beam CT imaging

Bosch

Öllers

Reymen

et al. 2017

Physics and Imaging in Radiation Oncology

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“…9 Such changes can be dealt by adaptive RT, whereby frequent three-dimensional (3D) imaging of lung tumour during the course of RT to detect meaningful tumour regression and applying replanning strategies to the regressed tumour volume for dose escalation and effective tumour control. 10 The optimal dose fractionation scheme for combined modality therapy in the context of Stage III non-small-cell lung cancer (NSCLC) is uncertain despite the results from the Radiation Therapy Oncology Group 0617 randomized controlled trial. 11 This trial has been criticized for reasons such as fewer patients on the high-dose arm completed consolidation chemotherapy, high-dose radiation given during 7.5 weeks allowed tumour repopulation to occur, treatment toxicity in the high-dose setting may have prompted inappropriately tight radiation fields, high-dose radiation was associated with a higher heart dose and that attributions of cause of death were inaccurate.…”

Section: Introductionmentioning

confidence: 99%

Potential for adaptive dose escalation in radiotherapy for patients with locally advanced non-small-cell lung cancer in a low mid income setting

Agrawal¹,

Kumar²,

Maurya³

2017

The British Journal of Radiology

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There is 35% reduction in tumour volume with chemoradiotherapy at 45 Gy which allows improvement in conformality, reduction in doses to the OARs and dose escalation in 40% of patients. Advances in knowledge: This article emphasizes that adaptive planning with a single diagnostic scan at 45 Gy has the potential for improvement of radiotherapy planning indices, dose escalation while respecting the dose to the OAR. This simple strategy can be helpful in radiotherapy planning upto 60 Gy in 40% of the patients of locally advanced non-small-cell lung cancer in countries with limited resources.

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“…Real-time adjustment of position errors can greatly improve the accuracy of patient positioning and effectively reduce the errors 16–22. IGRT technology is definitely very helpful and contributes a lot to the accuracy of radiotherapy to an unprecedented level.…”

Section: Discussionmentioning

confidence: 99%

Effect of image-guided hypofractionated stereotactic radiotherapy on peripheral non-small-cell lung cancer

Wang

Ren

Yan

et al. 2016

OTT

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The objective of this study was to compare the effects of image-guided hypofractionated radiotherapy and conventional fractionated radiotherapy on non-small-cell lung cancer (NSCLC). Fifty stage- and age-matched cases with NSCLC were randomly divided into two groups (A and B). There were 23 cases in group A and 27 cases in group B. Image-guided radiotherapy (IGRT) and stereotactic radiotherapy were conjugately applied to the patients in group A. Group A patients underwent hypofractionated radiotherapy (6–8 Gy/time) three times per week, with a total dose of 64–66 Gy; group B received conventional fractionated radiotherapy, with a total dose of 68–70 Gy five times per week. In group A, 1-year and 2-year local failure survival rate and 1-year local failure-free survival rate were significantly higher than in group B (P<0.05). The local failure rate (P<0.05) and distant metastasis rate (P>0.05) were lower in group A than in group B. The overall survival rate of group A was significantly higher than that of group B (P=0.03), and the survival rate at 1 year was 87% vs 63%, (P<0.05). The median survival time of group A was longer than that of group B. There was no significant difference in the incidence of complications between the two groups (P>0.05). Compared with conventional fractionated radiation therapy, image-guided hypofractionated stereotactic radiotherapy in NSCLC received better treatment efficacy and showed good tolerability.

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Cone-beam CT-guided radiotherapy in the management of lung cancer

Abstract: Weekly CBCT monitoring provides an adaptation advantage in patients with lung cancer. In this study, the monitoring allowed for plan adaptations due to tumor volume changes and to other anatomical changes.

Cited by 32 publications

References 32 publications

Automatic selection of lung cancer patients for adaptive radiotherapy using cone-beam CT imaging

Automatic selection of lung cancer patients for adaptive radiotherapy using cone-beam CT imaging

Potential for adaptive dose escalation in radiotherapy for patients with locally advanced non-small-cell lung cancer in a low mid income setting

Effect of image-guided hypofractionated stereotactic radiotherapy on peripheral non-small-cell lung cancer

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