Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): An Introduction to the Scientific Issues

Bentzen, Søren M.; Constine, Louis S.; Deasy, Joseph O.; Eisbruch, A.; Jackson, Andrew; Marks, Lawrence B.; Haken, Randall K. Ten; Yorke, Ellen

doi:10.1016/j.ijrobp.2009.09.040

Cited by 969 publications

(707 citation statements)

References 40 publications

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“…Risk estimate comparison studies of IFRT techniques for HL, including volumetric‐modulated arc therapy and proton therapy by Maraldo et al, 11 , 19 also use linear models for calculation of secondary cancer risk. In our work, the risk of radiation‐induced cardiac mortality was evaluated based on the dose‐volume distribution to the heart using the logistic relative seriality model, in accordance with the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) (20) . Risks for induction of secondary cancers in specific organs, lung and breast, were assessed using a linear quadratic model as modified by Schneider; (14) this model adapts the concept of organ‐equivalent dose to account for nonhomogeneous dose distributions within an organ.…”

Section: Introductionmentioning

confidence: 99%

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Toltz

Shin

Mitrou

et al. 2015

J Applied Clin Med Phys

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In 2010, all young patients treated for intrathoracic Hodgkin lymphoma (HL) at one of 10 radiotherapy centers in the province of Quebec received 3D conformal photon therapy. These patients may now be at risk for late effects of their treatment, notably secondary malignancies and cardiac toxicity. We hypothesized that more complex radiotherapy, including intensity‐modulated proton therapy (IMPT) and possibly IMRT (in the form of helical tomotherapy (HT)), could benefit these patients. With institutional review board approval at 10 institutions, all treatment plans for patients under the age of 30 treated for HL during a six‐month consecutive period of 2010 were retrieved. Twenty‐six patients were identified, and after excluding patients with extrathoracic radiation or treatment of recurrence, 20 patients were replanned for HT and IMPT. Neutron dose for IMPT plans was estimated from published measurements. The relative seriality model was used to predict excess risk of cardiac mortality. A modified linear quadratic model was used to predict the excess absolute risk for induction of lung cancer and, in female patients, breast cancer. Model parameters were derived from published data. Predicted risk for cardiac mortality was similar among the three treatment techniques (absolute excess risk of cardiac mortality was not reduced for HT or IMPT (p>0.05,p>0.05) as compared to 3D CRT). Predicted risks were increased for HT and reduced for IMPT for secondary lung cancer (p<0.001,p<0.001) and breast cancers (p<0.001,p<0.001) as compared to 3D CRT.PACS numbers: 87.55.dh, 87.55.dk

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Section: Introductionmentioning

confidence: 99%

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Toltz

Shin

Mitrou

et al. 2015

J Applied Clin Med Phys

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“…The irradiated doses to OARs in Plans A and B were both within conventionally tolerated limits, according to the report of Emami et al (11) or Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) (12) . Plan B has an advantage in decreasing doses to hippocampi, whereas it has a tendency to increase doses to parotid glands.…”

Section: Discussionmentioning

confidence: 91%

Dosimetric advantages of O‐ring design radiotherapy system for skull‐base tumors

Ogura

Mizowaki

Ishida

et al. 2014

J Applied Clin Med Phys

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The purpose of this study was to investigate whether a new O‐ring design radiotherapy delivery system has advantages in radiotherapy planning for skull‐base tumors. Twenty‐five patients with skull‐base tumors were included in this study. Two plans were made using conventional (Plan A) or new (Plan B) techniques. Plan A consisted of four dynamic conformal arcs (DCAs): two were horizontal, and the other two were from cranial directions. Plan B was created by converting horizontal arcs to those from caudal directions making use of the O‐ring design radiotherapy system. The micromultileaf collimators were fitted to cover at least 99% of the planning target volume with prescribed doses, 90% of the dose at the isocenter. The two plans were compared in terms of target homogeneity, conformity, and irradiated volume of normal tissues, using a two‐sided paired t‐test. For evaluation regarding target coverage, the homogeneity indices defined by the International Commission on Radiation Units and Measurements 83 were 0.099±0.010 (mean ± standard deviation) and 0.092±0.010, the conformity indices defined by the Radiation Therapy Oncology Group were 1.720±0.249 and 1.675±0.239, and the Paddick's conformity indices were 0.585±0.078 and 0.602±0.080, in Plans A and B, respectively. For evaluation of irradiated normal tissue, the Paddick's gradient indices were 3.118±0.283 and 2.938±0.263 in Plans A and B, respectively. All of these differences were statistically significant (p‐values <0.05). The mean doses of optic nerves, eyes, brainstem, and hippocampi were also significantly lower in Plan B. The DCA technique from caudal directions using the new O‐ring design radiotherapy system can improve target homogeneity and conformity compared with conventional DCA techniques, and can also decrease the volume of surrounding normal tissues that receives moderate doses.PACS numbers: 87.55.‐x, 87.55.D‐, 87.55.dk

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“…All three treatment techniques will be calculated using 6 and 10 MV energy to allow an intra-study comparison between energies. All three treatment plan constraints are motivated by 'RTOG 126: A phase III study on 3DCRT/IMRT prostate cancer' and 'Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC)' [13,14]. All treatment plans are to be calculated within Monaco treatment planning software, first using the initial finite size pencil beam (FSPB) algorithm followed by the (XVMC) X-ray Voxel Monte Carlo dose calculation calculated with a 1% statistical uncertainty and 1mm voxel size [15].…”

Section: A) Radiation Therapy Treatment Planningmentioning

confidence: 99%

A comparison of planned radiotherapy dose distributions calculated by Monte Carlo with variation of technique, statistical uncertainty and voxel size on resulting gamma pass rates

Delinder

2017

Preprint

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Background: The gamma analysis index () is the most commonly used method to compare a calculated and measured dose distribution. A caveat to the clinical use of  is that the formalism does have a sensitivity to noise present in either distribution. Monte Carlo (MC) based dose calculation methods are widely accepted as the most accurate method to calculate a resulting patient dose distribution from a radiation therapy treatment plan [6]. However, noise is inherently present as random errors or statistical uncertainty within all MC based dose calculation methods and is inversely proportional to the dose calculation time [7]. A research experiment performed by Van Delinder et al. investigated the effect of decreasing voxel size and increasing statistical uncertainty for a Monte Carlo based dose calculation method using 10 clinical head and neck (H&N) IMRT treatment plans. The experimental result was a definitive increase in  passing rates with combined decrease in voxel size [10]. In order to further clinical information regarding this phenomenon, a large comprehensive study is required using multiple treatment techniques, a different treatment site, and using a different type of radiation measurement device.

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Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): An Introduction to the Scientific Issues

Cited by 969 publications

References 40 publications

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Dosimetric advantages of O‐ring design radiotherapy system for skull‐base tumors

A comparison of planned radiotherapy dose distributions calculated by Monte Carlo with variation of technique, statistical uncertainty and voxel size on resulting gamma pass rates

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