Detection of organ movement in cervix cancer patients using a fluoroscopic electronic portal imaging device and radiopaque markers

Kaatee, R. S. J. P.; Olofsen, Manouk J.J; Verstraate, Marjolein; Quint, S.; Heijmen, B.

doi:10.1016/s0360-3016(02)02953-x

Cited by 67 publications

(43 citation statements)

References 26 publications

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“…Therefore, CTV coverage was consistent with expectations from the model proposed by Khan et al (23), and we consider this expansion strategy to be valid. Previous reports have generally recommended margins of approximately 15 mm around the uterus and cervix, which is in line with the Khan et al model and with our results (15)(16)(17)(18)29). To our knowledge, this is the first well-powered, independent and hypothesis-driven validation of a model for PTV margin expansion in the setting of intact cervical cancer that takes advantage of prospectively collected daily imaging data.…”

Section: Discussionsupporting

confidence: 89%

“…Other potential drivers of miss include bowel and bladder filling (30), which were not assessed in this study. Moreover, internal uterus motion, such as conversion between anteflexed and retroflexed states, likely plays a large role (29,31). Baseline uterine position (ie, anteverted, midplane, retroverted) and/or intention to treat with a full or empty bladder could also affect coverage.…”

Section: Discussionmentioning

confidence: 99%

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Prospective Validation of a High-Dimensional Shape Model for Organ Motion in Intact Cervical Cancer

Williamson

Green

Noticewala

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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SummaryWe sought to validate a strategy for planning target volume definition in patients with intact cervical cancer, based on a previously published shape model. Using daily cone beam computed tomography imaging from patients treated with intensity modulated radiation therapy, we found that 92.3% of target volumes were entirely encompassed within the 95% isodose structure, which was not significantly lower than our hypothesized probability of 95.0% (PZ.19). Therefore, we consider this expansion strategy to be valid.Purpose: Validated models are needed to justify strategies to define planning target volumes (PTVs) for intact cervical cancer used in clinical practice. Our objective was to independently validate a previously published shape model, using data collected prospectively from clinical trials. Methods and Materials: We analyzed 42 patients with intact cervical cancer treated with daily fractionated pelvic intensity modulated radiation therapy and concurrent chemotherapy in one of 2 prospective clinical trials. We collected online cone beam computed tomography (CBCT) scans before each fraction. Clinical target volume (CTV) structures from the planning computed tomography scan were cast onto each CBCT scan after rigid registration and manually redrawn to account for organ motion and deformation. We applied the 95% isodose cloud from the planning computed tomography scan to each CBCT scan and computed any CTV outside the 95% isodose cloud. The primary aim was to determine the proportion of CTVs that were encompassed within the 95% isodose volume. A 1-sample t test was used to test the hypothesis that the probability of complete coverage was different from 95%. We used mixed-effects logistic regression to assess effects of time and patient variability. Results: The 95% isodose line completely encompassed 92.3% of all CTVs (95% confidence interval, 88.3%-96.4%), not significantly different from the 95% probability anticipated a priori (PZ.19). The overall proportion of missed CTVs was small: the grand mean of covered CTVs was 99.9%, and 95.2% of misses were located in the anterior body of the uterus. Time did not affect coverage probability (PZ.71). definition strategy based on a shape model for intact cervical cancer, the probability of CTV coverage was high and the volume of CTV missed was low. This PTV expansion strategy is acceptable for clinical trials and practice; however, we recommend daily image guidance to avoid systematic large misses in select patients. Ó

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Prospective Validation of a High-Dimensional Shape Model for Organ Motion in Intact Cervical Cancer

Williamson

Green

Noticewala

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…Multiple studies have found that the uterus and cervix can move and regress substantially during treatment (11)(12)(13)(14)(15)(16)(17)(18). Consequently, there is concern that such motion could lead to insufficient target coverage, compromising tumor control.…”

Section: Introductionmentioning

confidence: 99%

Daily Online Cone Beam Computed Tomography to Assess Interfractional Motion in Patients With Intact Cervical Cancer

Tyagi

Lewis

Yashar

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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“…Firstly, the cervix is not a fixed pelvic organ, rather one that is subject to movement during treatment [28,29]. It was assumed that the target moves together with the applicator and the applicator was fixed to a board so that applicator guided IGRT would minimize setup uncertainties.…”

Section: Discussionmentioning

confidence: 99%

Image Guided Radiation Therapy Boost in Combination With High-Dose-Rate Intracavitary Brachytherapy for the Treatment of Cervical Cancer

Wang

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose: The purpose of this study was to demonstrate the dosimetric and clinical feasibility of image guided radiation therapy (IGRT) combined with high-dose-rate (HDR) intracavitary brachytherapy (ICBT) to improve dose distribution in cervical cancer treatment.Material and methods: For 42 cervical cancer patients, magnetic resonance imaging (MRI) scans were acquired after completion of whole pelvic irradiation 45-46 Gy and 5 fractions of B + I (ICBT + IGRT) treatment were subsequently received. The high risk clinical target volume (HRCTV), intermediate risk clinical target volume (IRCTV), bladder, rectum, and sigmoid were contoured on the computed tomography (CT) scans. The total planning aim doses for HRCTV was D 90% > 85 Gy, whilst constraints for rectum and sigmoid were D 2cc < 75 Gy and D 2cc < 90 Gy for bladder in terms of an equivalent dose in 2 Gy (EQD2) for external beam radiotherapy (EBRT) and brachytherapy boost. The IGRT plan was optimized on top of the ICBT dose distribution. A dosimetric comparison was made between B + I and optimized ICBT (O-ICBT) only.Results: The mean D 90% of HRCTV was comparable for B + I and O-ICBT (p = 0.82). For B + I plan, HRCTV D 100% , IRCTV D 100% , and IRCTV D 90% were significantly increased by a mean of 10.52 Gy, 5.61 Gy, and 2.70 Gy, respectively (p < 0.01). The D 2cc for bladder, rectum, and sigmoid were lower by a mean of 21.36, 6.78, and 10.65 Gy, respectively (p < 0.01). The mean rectum V60 Gy value over 42 patients was almost the same for both techniques but for bladder and sigmoid B + I had higher V60 Gy mean values as compared with the O-ICBT.Conclusions: B + I can improve dose distribution in cervical cancer treatment; it could be useful for tumors extended beyond the reach of intracavitary/interstitial brachytherapy (IC/ISBT) or for centers that are inexperienced or illequipped with IC/ISBT techniques. Additional confirmatory prospective studies with larger numbers of patients and longer follow-up are required to validate the durability.

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Detection of organ movement in cervix cancer patients using a fluoroscopic electronic portal imaging device and radiopaque markers

Cited by 67 publications

References 26 publications

Prospective Validation of a High-Dimensional Shape Model for Organ Motion in Intact Cervical Cancer

Prospective Validation of a High-Dimensional Shape Model for Organ Motion in Intact Cervical Cancer

Daily Online Cone Beam Computed Tomography to Assess Interfractional Motion in Patients With Intact Cervical Cancer

Image Guided Radiation Therapy Boost in Combination With High-Dose-Rate Intracavitary Brachytherapy for the Treatment of Cervical Cancer

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