Role of stereotactic body radiotherapy in gynecologic radiation oncology

Shenker, R.F.; Stephens, Sarah Jo; Davidson, Brittany; Chino, Junzo

doi:10.1136/ijgc-2021-002466

Cited by 12 publications

(7 citation statements)

References 52 publications

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“…IGBT using 3D images for RT planning allows for more precise and individualized treatment compared even to stereotactic body radiotherapy (SBRT) [23][24] . However, modern IGBT procedures with increasing real-time steps and complexities will require for more technical and manpower resources before con dent applications.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of auto-segmentation for brachytherapy of postoperative cervical cancer using deep learning-based workflow

Wang

Chen

et al. 2022

Preprint

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Objective: The purpose of this study was to evaluate the accuracy of brachytherapy (BT) planning structures derived from Deep learning (DL) based auto-segmentation compared with standard manual delineation for postoperative cervical cancer. Methods: We introduced a convolutional neural networks (CNN) which was developed and presented for auto-segmentation in cervical cancer radiotherapy. The dataset of 60 patients received BT of postoperative cervical cancer was used to train and test this model for delineation of high-risk clinical target volume (HRCTV) and organs at risk (OARs). Dice similarity coefficient (DSC), 95% hausdorff distance (95%HD), jaccard coefficient (JC) and dose-volume index (DVI) were used to evaluate the accuracy. The correlation between geometric metrics and dosimetric difference was performed by Spearman’s correlation analysis. The radiation oncologists scored the auto-segmented contours by rating the lever of satisfaction (no edits, minor edits, major edits). Results: The mean DSC values of DL based model were 0.87, 0.94, 0.86, 0.79 and 0.92 for HRCTV, bladder, rectum, sigmoid and small intestine, respectively. The Bland-Altman test obtained dose agreement for HRCTV_D90%, HRCTV_Dmean, bladder_D2cc, sigmoid_D2cc and small intestine_D2cc. Wilcoxon’s signed-rank test indicated significant dosimetric differences in bladder_D0.1cc, rectum_D0.1cc and rectum_D2cc (P<0.05). A strong correlation between HRCTV_D90% with its DSC (R=-0.842, P=0.002) and JC (R=-0.818, P=0.004) were found in Spearman’s correlation analysis. From the physician review, 80% of HRCTVs and 72.5% of OARs in the test dataset were shown satisfaction (no edits). Conclusion: The proposed DL based model achieved a satisfied agreement between the auto-segmented and manually defined contours of HRCTV and OARs, although the clinical acceptance of small volume dose of OARs around the target was a concern. DL based auto-segmentation was an essential component in cervical cancer workflow which would generate the accurate contouring.

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Section: Discussionmentioning

confidence: 99%

Evaluation of auto-segmentation for brachytherapy of postoperative cervical cancer using deep learning-based workflow

Wang

Chen

et al. 2022

Preprint

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“…SBRT is widely used for the treatment of a wide variety of other primary and metastatic cancers. [1][2][3][4] In particular,for pelvic lymph node (LN) oligometastases,one-year local control of 74% 5 or higher 6 can be achieved with a mild risk of toxicities. For the clinical performance of SBRT, dedicated systems and regular clinical linear accelerators (Linacs) are employed.…”

Section: Introductionmentioning

confidence: 99%

“…This results in a high biologically effective dose within the target and rapidly falling off doses away from the target, potentially maximizing tumor control and minimizing normal tissue damage. SBRT is widely used for the treatment of a wide variety of other primary and metastatic cancers 1–4 . In particular, for pelvic lymph node (LN) oligometastases, one‐year local control of 74% 5 or higher 6 can be achieved with a mild risk of toxicities.…”

Section: Introductionmentioning

confidence: 99%

Quality assessment of automatically planned O‐Ring linac SBRT plans for pelvic lymph node metastases, finding the optimal minimum target size by comparison with robotic SBRT

Hernández,

Unterkirhers,

Schneider

2023

J Applied Clin Med Phys

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PurposeThe purpose of this study is to assess the quality of automatic planned O‐Ring Halcyon linac SBRT plans for pelvic lymph node metastases and to establish an absolute PTV volume threshold as a plan quality prediction criterion. Compliance of the plans to institutional SBRT plan evaluation criteria and differences in plan quality and treatment delivery times between Halcyon Linac and CyberKnife robotic SBRT were evaluated.MethodsTwenty‐one CyberKnife treatment plans were replanned for Halcyon. Prescription doses range was 26–40 Gy in mean three fractions. The mean/median planning target volume was 4.0/3.6 cm3. Institutional criteria for the plan evaluation were: New Conformity Index (NCI), Conformity Index (CI), Modified Gradient Index (MGI), selectivity index reciprocal (PIV/TVPIV), and the target coverage by prescription isodose (%PIV). Statistical analysis based on the receiver operating characteristic (ROC) curve was used to determine a plan quality predictor threshold of the PTV volume. Comparative analysis of normal tissue complication probabilities (NTCP) was used to assess the risk of toxicity in healthy tissues.ResultsSeventy‐one percent (n = 15)/95% (n = 20) of Halcyon and 81% (n = 17)/100% (n = 21) of CK plans fulfilled all ideal/tolerance criteria. For PTVs above a found optimal threshold of 2.6 cm3 (71%, n = 15), no statistically significant difference was observed between the CI, NCI, PIV/TVPIV, and MGI indexes of both groups, while the coverage (%PIV) was statistically but not clinically significantly different between cohorts. Significantly shorter delivery times are expected with Halcyon. No significant differences in NTCP were observed.ConclusionAll but one automatically optimized Halcyon treatment plans demonstrated ideal or acceptable performance. PTV threshold of 2.6 cm3 can be used as decision criteria in clinical settings. The results of our study demonstrated the promising performance of the Halcyon for pelvic SBRT, although plan‐specific QA is required to verify machine performance during plan delivery.

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“…Several reviews reported promising results in terms of local control and survival regarding use of SBRT in recurrent gynaecological cancer [38,39].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Gynecological Tumors in Previously Irradiated Patients. Does Re-Irradiation with Stereotactic Body Radiotherapy Have a Role? A Systematic Review

Pontoriero,

Critelli,

Bosurgi

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background: Re-irradiation of patients with previously irradiated gynecological tumors represents one of the hot topics of modern oncology. It is generally performed using Brachytherapy (alone or after external beam radiation therapy (EBRT) re-treatment) or Stereotactic Body Radiotherapy (SBRT). Literature provides few data concerning SBRT re-irradiation (re-RT). Here we provided a statistical and comparative analysis of the studies to make a general assessment of the efficacy and reliability of SBRT, considering the potential benefits achievable in terms of local control, overall survival and toxicity. Methods: A computerized literature search was performed in 3 electronic databases (MEDLINE, EMBASE, and Cochrane) from 1996 to 2020. Only studies analysing outcomes of re-irradiated (re-I) patients were taken into consideration. Quality assessment score and risk of bias were assessed for each article. Random-effects models were used due to great subjectivity given the lack of related control groups in the non-comparative studies and a tendency towards high heterogeneity (examined by the Cochran Q chi-square test and the I 2 statistic). To determine the pooled 2-year Overall Survival (OS) and 2-year Local Control (LC) and ≥Grade 3 (G3) treatment-related toxicities, an established meta-analysis technique over single and multi-arm studies was performed. Results: Of 21 articles focusing on the role of SBRT in recurrent gynaecological cancers, were identified. Only 7 articles, published between 2009 and 2020, with outcomes limited to re-I patients and specific radiotherapy techniques were included. The selected studies counted a total of 196 patients, 157 of whom were previously irradiated. With a median follow up time of 14.5 months, using SBRT re-I technique, the pooled 2-year OS of 52.7% (95% confidence interval (CI): 0.372 to 0.651) and 2-year LC of 75.7% (95% CI: 0.614 to 0.852) were observed. SBRT re-irradiation technique does not affect toxicities with pooled ≥G3 late toxicities being 8.7% (95% CI: -0.0944 to 0.267). Conclusions: According to our review, SBRT re-irradiation technique seems to be feasible and safe, when brachytherapy re-RT technique is not available. Further studies are warranted to standardize the best radiation therapy in recurrent gynaecological cancer.

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Role of stereotactic body radiotherapy in gynecologic radiation oncology

Cited by 12 publications

References 52 publications

Evaluation of auto-segmentation for brachytherapy of postoperative cervical cancer using deep learning-based workflow

Evaluation of auto-segmentation for brachytherapy of postoperative cervical cancer using deep learning-based workflow

Quality assessment of automatically planned O‐Ring linac SBRT plans for pelvic lymph node metastases, finding the optimal minimum target size by comparison with robotic SBRT

Recurrent Gynecological Tumors in Previously Irradiated Patients. Does Re-Irradiation with Stereotactic Body Radiotherapy Have a Role? A Systematic Review

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