Volume de-escalation in radiation therapy: state of the art and new perspectives

Meduri, Bruno; Gregucci, Fabiana; D’Angelo, Elisa; Alitto, A.R.; Ciurlia, E.; Desideri, Isacco; Marino, Lorenza; Borghetti, Paolo; Fiore, Michele; Fiorentino, Alba

doi:10.1007/s00432-020-03152-7

Cited by 19 publications

(15 citation statements)

References 126 publications

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“…However, those that from a certain point of view are advantages, could also be considered the major disadvantages of GK-based-SRT. Due to the technological advancement, including frameless and patient's comfort, interest in Linac-based-SRT is increasing considerably [3][4][5][6][10][11][12][13][14][15]. In this context, the current identification of margins from CTV to PTV that accounts for organ motion and deformation and for setup uncertainties due to patient daily positioning variations, is crucial.…”

Section: Discussionmentioning

confidence: 99%

“…With the continuous improvement of techniques and technologies available today, the purpose of modern RT is to reduce the exposure of healthy tissues to irradiation and improve the accuracy in delivering of therapeutic doses to target lesion. A crucial point for Linac-based RT to reach this progress is the optimal definition of "safety margins" from Gross Tumor Volume (GTV) or Clinical Target Volume (CTV) to Planning Target Volume (PTV), whose amplitude considers the setup errors [6]. Inevitably, to reduce planning margins, first, this process must go through the improvement of the immobilization systems to ensure the correct and reproducible positioning of the patient at the beginning and during RT and, at the same time, the possibility of monitoring the correct maintenance of this position during RT delivery.…”

Section: Introductionmentioning

confidence: 99%

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Brain Linac-Based Radiation Therapy: “Test Drive” of New Immobilization Solution and Surface Guided Radiation Therapy

Gregucci

Bonaparte

Surgo

et al. 2021

JPM

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Aim: To test inter-fraction reproducibility, intrafraction stability, technician aspects, and patient/physician’s comfort of a dedicated immobilization solution for Brain Linac-based radiation therapy (RT). Methods: A pitch-enabled head positioner with an open-face mask were used and, to evaluate inter- and intrafraction variations, 1–3 Cone-Beam Computed Tomography (CBCT) were performed. Surface Guided Radiation Therapy (SGRT) was used to evaluate intrafraction variations at 3 time points: initial (i), final (f), and monitoring (m) (before, end, and during RT). Data regarding technician mask aspect were collected. Results: Between October 2019 and April 2020, 69 patients with brain disease were treated: 45 received stereotactic RT and 24 conventional RT; 556 treatment sessions and 863 CBCT’s were performed. Inter-fraction CBCT mean values were longitudinally 0.9 mm, laterally 0.8 mm, vertically 1.1 mm, roll 0.58°, pitch 0.59°, yaw 0.67°. Intrafraction CBCT mean values were longitudinally 0.3 mm, laterally 0.3 mm, vertically 0.4 mm, roll 0.22°, pitch 0.33°, yaw 0.24°. SGRT intrafraction mean values were: i_, m_, f_ longitudinally 0.09 mm, 0.45 mm, 0.31 mm; i_, m_, f_ laterally 0.07 mm, 0.36 mm, 0.20 mm; i_, m_, f_ vertically 0.06 mm, 0.31 mm, 0.22 mm; i_, m_, f_ roll 0.025°, 0.208°, 0.118°; i_, m_, f_ pitch 0.036°, 0.307°, 0.194°; i_, m_, f_ yaw 0.039°, 0.274°, 0.189°. Conclusions: This immobilization solution is reproducible and stable. Combining CBCT and SGRT data confirm that 1 mm CTV-PTV margin for Linac-based SRT was adequate. Using open-face mask and SGRT, for conventional RT, radiological imaging could be omitted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Brain Linac-Based Radiation Therapy: “Test Drive” of New Immobilization Solution and Surface Guided Radiation Therapy

Gregucci

Bonaparte

Surgo

et al. 2021

JPM

Self Cite

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“…Subsequently, CBCT‐guided RT and better positioning devices led to a decrease in the systematic error and therefore smaller PTV and PRV expansions 15–23 . Smaller PTV expansions, advanced equipment and treatment techniques led to conformal avoidance with the possibility to use dose‐escalated and/or more hypofractionated radiation protocols in sinonasal and other tumors in dogs 4,9,24–28 . Intensity‐modulated and volumetric‐modulated arc RT allows the planner to actively choose how much dose is deposited in a certain region.…”

Section: Discussionmentioning

confidence: 99%

Estimation of planning organ at risk volumes for ocular structures in dogs undergoing three‐dimensional image‐guided periocular radiotherapy with rigid bite block immobilization

Wolf

Bley

Besserer

et al. 2021

Vet Radiology Ultrasound

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Planning organ at risk volume (PRV) estimates have been reported as methods for sparing organs at risk (OARs) during radiation therapy, especially for hypofractioned and/or dose‐escalated protocols. The objectives of this retrospective, analytical, observational study were to evaluate peri‐ocular OAR shifts and derive PRVs in a sample of dogs undergoing radiation therapy for periocular tumors. Inclusion criteria were as follows: dogs irradiated for periocular tumors, with 3D‐image‐guidance and at least four cone‐beam CTs (CBCTs) used for position verification, and positioning in a rigid bite block immobilization device. Peri‐ocular OARs were contoured on each CBCT and the systematic and random error of the shifts in relation to the planning CT position computed. The formula 1.3×Σ+0.5xσ was used to generate a PRV of each OAR in the dorsoventral, mediolateral, and craniocaudal axis. A total of 30 dogs were sampled, with 450 OARs contoured, and 2145 shifts assessed. The PRV expansion was qualitatively different for each organ (1‐4 mm for the dorsoventral and 1‐2 mm for the mediolateral and craniocaudal axes). Maximal PRV expansion was ≤4 mm and directional for the majority; most pronounced for corneas and retinas. Findings from the current study may help improve awareness of and minimization of radiation dose in peri‐ocular OARs for future canine patients. Because some OARs were difficult to visualize on CBCTs and/ or to delineate on the planning CT, authors recommend that PRV estimates be institution‐specific and applied with caution.

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“…To our knowledge, there are three available randomised clinical trials comparing APBI and WBI that include a group treated with these techniques in the APBI arm GEC-ESTRO, NSABP B-39/RTOG 0413, and Budapest trials, with 88, 120, and 128 patients treated in this manner, respectively [17], [19], [18]. Although the APBI is a fascinating radiotherapy technique [34], it is still little used probably in relation to the experience of the centers and the availability of technologies [35].…”

Section: Discussionmentioning

confidence: 99%

Comparison between Accelerated Partial Breast Irradiation with multicatheter interstitial brachytherapy and Whole Breast Irradiation, in clinical practice

et al. 2021

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The aim of this study was to compare accelerated partial breast irradiation (APBI) with multicatheter interstitial brachytherapy (BT) and whole breast irradiation (WBI), in terms of toxicity, aesthetic result, quality of life and survival, in clinical practice. Materials and methods A comparative study of two prospectively recorded cohorts of 76 breast cancer patients who complied with the recommendations of GEC-ESTRO for APBI was conducted. The main objective was toxicity, quality of life measured through validated questionnaires and the aesthetic results. Secondary objectives were overall survival and disease-free survival. Results Seventy-six stage I/II breast cancer patients, with a mean age of 66 years entered the study. APBI group showed less acute G1-2 dermatitis (51.4 vs 94.9%, p < 0.001) and late hyperpigmentation (0 vs 17.9%, p = 0.04). There were no differences in aesthetic results, both assessed by the patient herself and by the doctor. Statistically significant differences in measures of quality of life were observed in favour of the APBI, both in EORTC QLQ-BR23 and body image scale questionnaires. With a median follow-up of 72 months (6 years), the estimated overall survival at 5 and 10 years was 96.8 and 77.7%, respectively, and disease-free survival at 5 and 10 years was 91.1 and 69.4%, respectively, without statistically significant differences between groups. Discussion APBI is an attractive alternative in candidate patients with initial breast cancer, with benefits in acute toxicity and quality of life and fewer visits to the hospital, without compromising tumor control or survival.

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Volume de-escalation in radiation therapy: state of the art and new perspectives

Cited by 19 publications

References 126 publications

Brain Linac-Based Radiation Therapy: “Test Drive” of New Immobilization Solution and Surface Guided Radiation Therapy

Brain Linac-Based Radiation Therapy: “Test Drive” of New Immobilization Solution and Surface Guided Radiation Therapy

Estimation of planning organ at risk volumes for ocular structures in dogs undergoing three‐dimensional image‐guided periocular radiotherapy with rigid bite block immobilization

Comparison between Accelerated Partial Breast Irradiation with multicatheter interstitial brachytherapy and Whole Breast Irradiation, in clinical practice

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