Planning Benchmark Study for Stereotactic Body Radiation Therapy of Liver Metastases: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery

Moustakis, Christos; Blanck, Oliver; Chan, Mark K.H.; Boda-Heggemann, Judit; Andratschke, Nicolaus; Duma, M.N.; Albers, D.; Bäumer, Christian; Fehr, R.; Körber, S; Schmidhalter, Daniel; Alraun, M; Baus, W.; Beckers, Eric; Dierl, M; Droege, Stefan; Tazehmahalleh, Fatemeh Ebrahimi; Fleckenstein, Jens; Gückenberger, Matthias; Heinz, C.; Henkenberens, Christoph; Hennig, A.; Köhn, Janett; Kornhuber, Christine; Krieger, Thomas; Loutfi-Krauss, Britta; Mayr, Martina; Oechsner, Markus; Pfeiler, T.; Pollul, Gerhard; Schöffler, J; Tümmler, H.; Ullm, C; Walke, Mathias; Weigel, R; Wertman, Maya; Wiehle, R.; Wiezorek, Tilo; Wilke, L.; Wolf, U.; Eich, H.T.; Schmitt, Daniela

doi:10.1016/j.ijrobp.2022.01.008

Cited by 11 publications

(7 citation statements)

References 36 publications

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“…This is probably because, on the one hand, the liver is relatively located on a superficial location, which facilitates stereotactic radiotherapy including 3D conformal radiotherapy techniques; on the other hand, pancreatic cancer has dense fibrous connective tissue, and this characteristic limits drug penetration to produce drug resistance while relatively limiting the tumor spread. Radiotherapy with radioactive particle implantation may be beneficial for patients with PCLM [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. Based on these risk factors for liver metastasis, prompt CT or MRI imaging is clinically indicated for patients with suspected PCLM.…”

Section: Discussionmentioning

confidence: 99%

Nomograms for Predicting the Risk and Prognosis of Liver Metastases in Pancreatic Cancer: A Population-Based Analysis

Shi

Zhou

et al. 2023

JPM

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The liver is the most prevalent location of distant metastasis for pancreatic cancer (PC), which is highly aggressive. Pancreatic cancer with liver metastases (PCLM) patients have a poor prognosis. Furthermore, there is a lack of effective predictive tools for anticipating the diagnostic and prognostic techniques that are needed for the PCLM patients in current clinical work. Therefore, we aimed to construct two nomogram predictive models incorporating common clinical indicators to anticipate the risk factors and prognosis for PCLM patients. Clinicopathological information on pancreatic cancer that referred to patients who had been diagnosed between the years of 2004 and 2015 was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression analyses and a Cox regression analysis were utilized to recognize the independent risk variables and independent predictive factors for the PCLM patients, respectively. Using the independent risk as well as prognostic factors derived from the multivariate regression analysis, we constructed two novel nomogram models for predicting the risk and prognosis of PCLM patients. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, the consistency index (C-index), and the calibration curve were then utilized to establish the accuracy of the nomograms’ predictions and their discriminability between groups. Using a decision curve analysis (DCA), the clinical values of the two predictors were examined. Finally, we utilized Kaplan–Meier curves to examine the effects of different factors on the prognostic overall survival (OS). As many as 1898 PCLM patients were screened. The patient’s sex, primary site, histopathological type, grade, T stage, N stage, bone metastases, lung metastases, tumor size, surgical resection, radiotherapy, and chemotherapy were all found to be independent risks variables for PCLM in a multivariate logistic regression analysis. Using a multivariate Cox regression analysis, we discovered that age, histopathological type, grade, bone metastasis, lung metastasis, tumor size, and surgery were all independent prognostic variables for PCLM. According to these factors, two nomogram models were developed to anticipate the prognostic OS as well as the risk variables for the progression of PCLM in PCLM patients, and a web-based version of the prediction model was constructed. The diagnostic nomogram model had a C-index of 0.884 (95% CI: 0.876–0.892); the prognostic model had a C-index of 0.686 (95% CI: 0.648–0.722) in the training cohort and a C-index of 0.705 (95% CI: 0.647–0.758) in the validation cohort. Subsequent AUC, calibration curve, and DCA analyses revealed that the risk and predictive model of PCLM had high accuracy as well as efficacy for clinical application. The nomograms constructed can effectively predict risk and prognosis factors in PCLM patients, which facilitates personalized clinical decision-making for patients.

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Section: Discussionmentioning

confidence: 99%

Nomograms for Predicting the Risk and Prognosis of Liver Metastases in Pancreatic Cancer: A Population-Based Analysis

Shi

Zhou

et al. 2023

JPM

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“…In this context, the multicenter planning studies of the DGMP Working Group have shown that these dosimetric differences depend more on techniques (IMAT, 3D-CRT, SF-IMRT, robotic radiosurgery) than on the planners [ 45 ]. The multiparameter dose prescription with normalization to GTV or ITV mean or median dose, pointed out by the authors, can harmonize the differences between different energies, flattened and unflattened, and matched and unmatched FFF beams, leading to further standardization of SBRT [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy with volumetric intensity-modulated arc therapy and flattening filter-free beams: dosimetric considerations

Brekner,

Imhoff,

Rödel

et al. 2023

Strahlenther Onkol

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Purpose The present study comparatively evaluates the impact of energy-matched flattening filter-free (FFF) photon beams with different energy levels on the physical-dosimetric quality of lung and liver stereotactic body radiotherapy (SBRT) treatment plans. Methods For this purpose, 54 different lung and liver lesions from 44 patients who had already received SBRT combined with volumetric modulated arc therapy (VMAT) were included in this retrospective planning study. Planning computed tomography scans already available were used for the renewed planning with 6 MV, 6 MV-FFF, 10 MV, and 10 MV-FFF under constant planning objectives. The treatment delivery data, dosimetric distributions, and dose–volume histograms as well as parameters such as the conformity index and gradient indices were the basis for the evaluation and comparison of treatment plans. Results A significant reduction of beam-on time (BOT) was achieved due to the high dose rates of FFF beams. In addition, we showed that for FFF beams compared to flattened beams of the same energy level, smaller planning target volumes (PTV) require fewer monitor units (MU) than larger PTVs. An equal to slightly superior target volume coverage and sparing of healthy tissue as well as organs at risk in both lung and liver lesions were found. Significant differences were seen mainly in the medium to lower dose range. Conclusion We found that FFF beams together with VMAT represent an excellent combination for SBRT of lung or liver lesions with shortest BOT for 10 MV-FFF but significant dose savings for 6 MV-FFF in lung lesions.

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“…Four-dimensional computed tomography (4DCT) (CT0, CT1…CT9) was acquired with 2 mm slice thickness using Siemens Medical Systems and transferred to the Eclipse TPS (Version 15.5). The gross tumor volumes (GTVs) were contoured on 4DCT by one senior radiation oncologist according international guidelines (20,33). The internal target volumes (ITVs) encompassing the whole respiratory tumor motion areas were generated after extension of GTVs and the final PTV was generated by uniformly expanding ITVs with a 5 mm margin.…”

Section: Patients and Target Delineationmentioning

confidence: 99%

“…Based on clinical requirements, experience, and customization, we pre-defined the initial optimization objectives. To ensure appropriate dose coverage and homogeneity, we optimized all plans, giving great weight for the PTV and less weight for OARs based on the as low as reasonably achievable (ALARA) concept (20). Typically, to achieve acceptable SBRT plans, the planner needs to introduce auxiliary structures frequently and adjust the constraints repeatedly.…”

Section: Treatment Planningmentioning

confidence: 99%

“…Thaper et al (19) studied whether the dynamic conformal arc integrated with the segment shape optimization and variable dose rate was superior to the classic VMAT. To harmonize liver SBRT practice and to fill the knowledge gap concerning the inter-system and inter-user differences for treatment techniques and treatment planning systems (TPS), Moustakis et al (20) performed a meaningful study of planning benchmark for SBRT of liver metastases and provided the best practice guidelines for users. Although the aforementioned studies have studied the feasibility, safety and efficiency of liver SBRT, and have potential benefits in terms of solving some issues, to the best of our knowledge, none of the studies that investigated the dosimetric impact of single-isocentre SBRT for multiple liver metastases (MLM), and the potential increase in dose spillage to the normal liver tissue using a single-isocentre technique has not yet been studied.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and dosimetric evaluation of single- and multi-isocentre stereotactic body radiation therapy for multiple liver metastases

et al. 2023

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ObjectivesSingle-isocentre volumetric-modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) improves treatment efficiency and patient compliance for patients with multiple liver metastases (MLM). However, the potential increase in dose spillage to normal liver tissue using a single-isocentre technique has not yet been studied. We comprehensively evaluated the quality of single- and multi-isocentre VMAT-SBRT for MLM and propose a RapidPlan-based automatic planning (AP) approach for MLM SBRT.MethodsA total of 30 patients with MLM (two or three lesions) were selected for this retrospective study. We manually replanned all patients treated with MLM SBRT by using the single-isocentre (MUS) and multi-isocentre (MUM) techniques. Then, we randomly selected 20 MUS and MUM plans for training to generate the single-isocentre RapidPlan model (RPS) and the multi-isocentre RapidPlan model (RPM). Finally, we used data from the remaining 10 patients to validate RPS and RPM.ResultsCompared with MUS, MUM reduced the mean dose delivered to the right kidney by 0.3 Gy. The mean liver dose (MLD) was 2.3 Gy higher for MUS compared with MUM. However, the monitor units, delivery time, and V20Gy of normal liver (liver-gross tumour volume) for MUM were significantly higher than for MUS. Based on validation, RPS and RPM slightly improved the MLD, V20Gy, normal tissue complications, and dose sparing to the right and left kidneys and spinal cord compared with manual plans (MUS vs RPS and MUM vs RPM), but RPS and RPM significantly increased monitor units and delivery time.ConclusionsThe single-isocentre VMAT-SBRT approach could be used for MLM to reduce treatment time and patient comfort at the cost of a small increase in the MLD. Compared with the manual plans, RapidPlan-based plans, especially RPS, have slightly improved quality.

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Planning Benchmark Study for Stereotactic Body Radiation Therapy of Liver Metastases: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery

Cited by 11 publications

References 36 publications

Nomograms for Predicting the Risk and Prognosis of Liver Metastases in Pancreatic Cancer: A Population-Based Analysis

Nomograms for Predicting the Risk and Prognosis of Liver Metastases in Pancreatic Cancer: A Population-Based Analysis

Stereotactic body radiotherapy with volumetric intensity-modulated arc therapy and flattening filter-free beams: dosimetric considerations

Feasibility and dosimetric evaluation of single- and multi-isocentre stereotactic body radiation therapy for multiple liver metastases

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