The value of image-guided intensity-modulated radiotherapy in challenging clinical settings

Treece, S.; Mukesh, M.; Rimmer, Y.; Tudor, S.; Dean, J.C.; Benson, Richard; Gregory, D.; Horan, Gail; Jefferies, Sarah; Russell, Simon; Williams, Matt; Wilson, Charles B.; Burnet, N.G.

doi:10.1259/bjr.20120278

Cited by 10 publications

(4 citation statements)

References 46 publications

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“…Approximately 440 new cases are treated per annum across our 2 TomoTherapy units, with about 45% prostate cancer, 24% head and neck cancer (HNC), 8% central nervous system (CNS) tumours and 23% other cases [7,15]. All patients are imaged daily.…”

Section: Methodsmentioning

confidence: 99%

“…Technical developments such as intensitymodulated radiotherapy (IMRT) have facilitated dose escalation and toxicity reduction by more effectively conforming the high dose volume to the shape of the target [1][2][3][4][5][6][7]. This is particularly true of tumour sites with complex irregular shapes.…”

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confidence: 99%

“…Online IGRT allows correction of both systematic (treatment preparation) and random (treatment delivery) errors [9,10], so that targeting can be more accurate [10], providing greater security of target coverage and reducing the dose to surrounding normal tissues [11,12]. The combination of IG-IMRT allows treatments previously considered impossible [7]. It may also allow planning target volume (PTV) margin reduction, although caution is required [13].…”

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confidence: 99%

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Image guidance protocols: balancing imaging parameters against scan time

Bates

Scaife²,

Tudor³

et al. 2013

BJR

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Objective: Optimisation of imaging protocols is essential to maximise the use of image-guided radiotherapy. This article evaluates the time for daily online imaging with TomoTherapy® (Accuray®, Sunnyvale, CA), separating mechanical scan acquisition from radiographer-led image matching, to estimate the time required for a clinical research study (VoxTox). Methods: Over 5 years, 18 533 treatments were recorded for 3 tumour sites of interest (prostate, head and neck and central nervous system). Data were collected for scan length, number of CT slices, slice thickness, scan acquisition time and image matching time.Results: The proportion of coarse thickness scans increased over time, with a move of making coarse scans as the default. There was a strong correlation between scan time and scan length. Scan acquisition requires 40 s of processing time. For coarse scans, each additional centimetre requires 8 s for acquisition. Image matching takes approximately 1.5 times as long, so each additional centimetre needs 20 s extra in total. Modest changes to the imaging protocol have minimal impact over the course of the day. Conclusion: This work quantified the effect of changes to clinical protocols required for research. The results have been found to be reassuring in the busy National Institutes of Health department. Advances in knowledge: This novel method of data collection and analysis provides evidence of the minimal impact of research on clinical turnover. Whilst the data relate specifically to TomoTherapy, some aspects may apply to other platforms in the future.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Image guidance protocols: balancing imaging parameters against scan time

Bates

Scaife²,

Tudor³

et al. 2013

BJR

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“…As a result of these technological advances, radiotherapy has undergone a major transformation over the past decade. Recent results have also shown that new techniques and dose escalation have increased the potential of disease-free survival [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Should We Reconsider the Necessity of a Refinement of Prostate Cancer Risk Classification and Radiotherapy Treatment Strategy? Experiences from a Retrospective Analysis of Data from a Single Institution

Temesfői

Herczeg

Lőcsei

et al. 2020

JCM

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Background: Radiation therapy has undergone significant technical development in the past decade. However, the complex therapy of intermediate-risk patients with organ-confined prostate carcinoma still poses many questions. Our retrospective study investigated the impact of selected components of the treatment process including radiotherapy, hormone deprivation, risk classification, and patients’ response to therapy. Methods: The impact of delivered dose, planning accuracy, duration of hormone deprivation, risk classification, and the time to reach prostate-specific antigen (PSA) nadir state were analyzed among ninety-nine individuals afflicted with organ-confined disease. Progression was defined as a radiological or biochemical relapse within five years from radiotherapy treatment. Results: We found that 58.3% of the progressive population consisted of intermediate-risk patients. The progression rate in the intermediate group was higher (21.9%) than in the high-risk population (12.1%). Dividing the intermediate group, according to the International Society of Urological Pathology (ISUP) recommendations, resulted in the non-favorable subgroup having the highest rate of progression (33.3%) and depicting the lowest percentage of progression-free survival (66.7%). Conclusion: Extended pelvic irradiation on the regional lymph nodes may be necessary for the ISUP Grade 3 subgroup, similarly to the high-risk treatment. Therapy optimization regarding the intermediate-risk population based on the ISUP subgrouping suggestions is highly recommended in the treatment of organ-confined prostate cancer.

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