Quality assurance of dysphagia-optimised intensity modulated radiotherapy treatment planning for head and neck cancer
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ABSTRACT:
SUBMITTER: Tyler J
PROVIDER: S-EPMC8560997 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeTo design and commission a head and neck (H&N) anthropomorphic phantom that the Imaging and Radiation Oncology Core Houston (IROC-H) can use to verify the quality of intensity-modulated proton therapy H&N treatments for institutions participating in National Cancer Institute-sponsored clinical trials.Materials and methodsThe phantom design was based on a generalized oropharyngeal tumor, including critical H&N structures (parotid glands and spinal cord). Radiochromic film and thermoluminescent dosimeter (TLD)-100 capsules were embedded in the phantom and used to evaluate dose delivery. A spot-scanning treatment plan with typical clinical constraints for H&N cancer was created by using the Eclipse analytic algorithm. The treatment plan was approved by a radiation oncologist and the phantom was irradiated 4 times. The measured dose distribution using a ±7%/4 mm gamma analysis (85% of pixels passing) and point doses were compared with the treatment planning system calculations. The prescribed target dose was 6 Gy (RBE) with 646.2 cGy (RBE) and 648.6 cGy (RBE) planned to the superior and inferior TLD, respectively.ResultsFor point dosimetry, the average measured-to-calculated dose ratios were 0.984 and 0.986 for the superior and inferior target TLD, respectively. Dose values for the superior and inferior target TLDs were 636.1 cGy and 639.6 cGy, respectively. For the relative dose comparison, the pixel passing rates for the axial and sagittal films, respectively, were 95.5% and 94.2% for trial 1, 97.3% and 93.2% for trial 2, 93.4% and 90.0% for trial 3, and 96.2% and 92.7% for trial 4.ConclusionThe anthropomorphic H&N phantom was successfully designed so that TLD measured-to-calculated ratios were within IROC-H's 7% acceptance criteria, 1.6% and 1.4% lower than expected for the superior and inferior target TLDs, respectively. All trials passed the 85% pixel passing criteria established at IROC-H for the relative dose comparison performed when using a gamma index of ±7%/4 mm.
| S-EPMC6871565 | biostudies-literature
Project description:The impact of radiotherapy (RT) quality assurance (QA) has been demonstrated by numerous studies and is particularly important for head and neck cancer (HNC) treatment due to the complexity of RT target volumes in this region and the multiple adjacent organs at risk. The RT planning process includes many critical steps including interpretation of diagnostic imaging, image fusion, target volume delineation (tumor, lymph nodes, and organs at risk), and planning. Each step has become highly complex, and precise and rigorous QA throughout the planning process is essential. The ultimate aim is to precisely deliver radiation dose to the target, maximizing the tumor dose and minimizing the dose to surrounding organs at risk, in order to improve the therapeutic index. It is imperative that RT QA programs should systematically control all aspects of the RT planning pathway and include regular end-to-end tests and external audits. However, comprehensive QA should not be limited to RT and should, where possible, also be implemented for surgery, systemic therapy, pathology, as well as other aspects involved in the interdisciplinary treatment of HNC.
| S-EPMC7081058 | biostudies-literature
Project description:This study evaluated the feasibility of utilizing a 3D-printed anthropomorphic patient-specific head phantom for patient-specific quality assurance (QA) in intensity-modulated radiotherapy (IMRT). Contoured left and right head phantoms were converted from DICOM to STL format. Fused deposition modeling (FDM) was used to construct an anthropomorphic patient-specific head phantom with a 3D printer. An established QA technique and the patient-specific head phantom were used to compare the calculated and measured doses. When the established technique was used to compare the calculated and measured doses, the gamma passing rate for ? ? 1 was 97.28%, while the gamma failure rate for ? > 1 was 2.72%. When the 3D-printed patient-specific head phantom was used, the gamma passing rate for ? ? 1 was 95.97%, and the gamma failure rate for ? > 1 was 4.03%. The 3D printed patient-specific head phantom was concluded to be highly feasible for patient-specific QA prior to complicated radiotherapy procedures such as IMRT.
| S-EPMC5519219 | biostudies-literature
Project description:Intensity-modulated proton therapy (IMPT) is highly sensitive to uncertainties in beam range and patient setup. Conventionally, these uncertainties are dealt using geometrically expanded planning target volume (PTV). In this paper, the authors evaluated a robust optimization method that deals with the uncertainties directly during the spot weight optimization to ensure clinical target volume (CTV) coverage without using PTV. The authors compared the two methods for a population of head and neck (H&N) cancer patients.Two sets of IMPT plans were generated for 14 H&N cases, one being PTV-based conventionally optimized and the other CTV-based robustly optimized. For the PTV-based conventionally optimized plans, the uncertainties are accounted for by expanding CTV to PTV via margins and delivering the prescribed dose to PTV. For the CTV-based robustly optimized plans, spot weight optimization was guided to reduce the discrepancy in doses under extreme setup and range uncertainties directly, while delivering the prescribed dose to CTV rather than PTV. For each of these plans, the authors calculated dose distributions under various uncertainty settings. The root-mean-square dose (RMSD) for each voxel was computed and the area under the RMSD-volume histogram curves (AUC) was used to relatively compare plan robustness. Data derived from the dose volume histogram in the worst-case and nominal doses were used to evaluate the plan optimality. Then the plan evaluation metrics were averaged over the 14 cases and were compared with two-sided paired t tests.CTV-based robust optimization led to more robust (i.e., smaller AUCs) plans for both targets and organs. Under the worst-case scenario and the nominal scenario, CTV-based robustly optimized plans showed better target coverage (i.e., greater D95%), improved dose homogeneity (i.e., smaller D5% - D95%), and lower or equivalent dose to organs at risk.CTV-based robust optimization provided significantly more robust dose distributions to targets and organs than PTV-based conventional optimization in H&N using IMPT. Eliminating the use of PTV and planning directly based on CTV provided better or equivalent normal tissue sparing.
| S-EPMC3651255 | biostudies-other
Project description:In this study, we present an intensity-modulated radiotherapy technique based on forward planning dose calculations to provide a concave dose distribution to the prostate and seminal vesicles by means of modified dynamic arc therapy (M-DAT). Dynamic arcs (350 degrees) conforming to the beam's eye view of the prostate and seminal vesicles while shielding the rectum, combined with two lateral oblique conformal fields (15 degrees with respect to laterals) fitting the prostate only,were applied to deliver doses of 78 Gy and 61.23 Gy in 39 fractions to the prostate and seminal vesicles respectively. Dynamic wedges (45 degrees of thick end, anteriorly oriented) were used with conformal beams to adjust the dose homogeneity to the prostate, although in some cases, hard wedges (30 degrees of thick part,inferiorly oriented) were used with arcs to adjust the dose coverage to the seminal vesicles. The M-DAT was applied to 10 patients in supine and 10 patients in prone positioning to determine the proper patient positioning for optimum protection of the rectum. The M-DAT was compared with the simplified intensity-modulated arc therapy (SIMAT) technique, composed of three phases of bilateral dynamic arcs. The mean rectal dose in M-DAT for prone patients was 22.5 +/- 5.1 Gy; in M-DAT and SIMAT for supine patients, it was 30.2 +/- 5.1 Gy and 39.4 +/- 6.0 Gy respectively. The doses to 15%, 25%, 35%, and 50% of the rectum volume in M-DAT for prone patients were 44.5 +/- 10.2 Gy, 33.0 +/- 8.2 Gy, 25.3 +/- 6.4 Gy, and 16.3 +/- 5.6 Gy respectively. These values were lower than those in M-DAT and in SIMAT for supine patients by 7.7%, 18.2%, 22.4%, and 28.5% and by 25.0%, 32.1%, 34.9%, and 41.9% of the prescribed dose (78 Gy) respectively. Ion chamber measurements showed good agreement of the calculated and measured isocentric dose (maximum deviation of 3.5%). Accuracy of the dose distribution calculation was evaluated by film dosimetry using a gamma index, allowing 3% dose variation and 4 mm distance to agreement as the individual acceptance criteria in prostate and seminal vesicle levels alike for all supine and prone patients. We found that fewer than 10% of the pixels in the dose distribution of the calculated area of10 x 10-cm failed the acceptance criteria. These pixels were observed mainly in the low-dose regions, particularly at the level of the seminal vesicles. In conclusion, the single-phase M-DAT technique with patients in the prone position was found to provide the intended coverage of the prescribed doses to the prostate and seminal vesicles with improved protection for the rectum. Accordingly, M-DAT has replaced non-modulated conformal radiotherapy or SIMAT as the standard treatment for prostate cancer in our department.
| S-EPMC5722620 | biostudies-literature
Project description:BackgroundImage-guided intensity-modulated radiotherapy (IG-IMRT) is increasingly being used to treat patients with soft-tissue sarcoma (STS) of the head and neck. Although there is no comparison between IMRT and conventional radiation therapy (CRT) concerning their efficacy. In this analysis, we compared CRT and IMRT outcomes for head and neck STS.Patients and methodsSixty-seven patients who underwent radiotherapy between 1994 and 2017 were identified.ResultsThe median follow-up was 31 months. Of the 67 patients, 34% were treated with CRT technique and 66% with IG-IMRT. The locoregional relapse rate following IMRT was 21% versus 70% with CRT (p<0.001) and the 5-year locoregional control was 69% versus 28%, respectively (p=0.01). IG-IMRT was associated with non-significant, less acute, and chronic adverse events. In the multivariate analysis, a significant influence of radiation technique on locoregional control was confirmed (p=0.04).ConclusionIG-IMRT seems to be associated both with higher locoregional control as well as lower acute and chronic toxicities.
| S-EPMC6689378 | biostudies-literature
Project description:Background and purposePlanning complex radiotherapy treatments can be inefficient, with large variation in plan quality. In this study we evaluated plan quality and planning efficiency using real-time interactive planning (RTIP) for head and neck (HN) volumetric modulated arc therapy (VMAT).Materials and methodsRTIP allows manipulation of dose volume histograms (DVHs) in real-time to assess achievable planning target volume (PTV) coverage and organ at risk (OAR) sparing. For 20 HN patients previously treated with VMAT, RTIP was used to minimize OAR dose while maintaining PTV coverage. RTIP DVHs were used to guide VMAT optimization. Dosimetric differences between RTIP-assisted plans and original clinical plans were assessed. Five blinded radiation oncologists indicated their preference for each PTV, OAR and overall plan. To assess efficiency, ten patients were planned de novo by experienced and novice planners and a RTIP user.ResultsThe average planning time with RTIP was <20 min, and most plans required only one optimization. All 20 RTIP plans were preferred by a majority of oncologists due to improvements in OAR sparing. The average maximum dose to the spinal cord was reduced by 10.5 Gy (from 49.5 to 39.0 Gy), and the average mean doses for the oral cavity, laryngopharynx, contralateral parotid and submandibular glands were reduced by 3.5 Gy (39.1-35.7 Gy), 6.8 Gy (42.5-35.7 Gy), 1.7 Gy (17.0-15.3 Gy) and 3.3 Gy (22.9-19.5 Gy), respectively.ConclusionsIncorporating RTIP into clinical workflows may increase both planning efficiency and OAR sparing.
| S-EPMC7807618 | biostudies-literature
Project description:Background and purposeVarious radiotherapy planning methods for locally advanced squamous cell carcinoma of the head and neck (SCCHN) have been proposed to decrease normal tissue toxicity. We compare IMRT, adaptive IMRT, proton therapy (IMPT), and adaptive IMPT for SCCHN.Materials and methodsInitial and re-simulation CT images from 10 consecutive patients with SCCHN were used to quantify dosimetric differences between photon and proton therapy. Contouring was performed on both CTs, and plans (n=40 plans) and dose-volume histograms were generated.ResultsThe mean GTV volume decreased 53.4% with re-simulation. All plans provided comparable PTV coverage. Compared with IMRT, adaptive IMRT significantly reduced the maximum dose to the mandible (p=0.020) and mean doses to the contralateral parotid gland (p=0.049) and larynx (p=0.049). Compared with IMRT and adaptive IMRT, IMPT significantly lowered the maximum doses to the spinal cord (p<0.002 for both) and brainstem (p<0.002 for both) and mean doses to the larynx (p<0.002 for both) and ipsilateral (p=0.004 IMRT, p=0.050 adaptive) and contralateral (p<0.002 IMRT, p=0.010 adaptive) parotid glands. Adaptive IMPT significantly reduced doses to all critical structures compared with IMRT and adaptive IMRT and several critical structures compared with non-adaptive IMPT.ConclusionsAlthough adaptive IMRT reduced dose to several normal structures compared with standard IMRT, non-adaptive proton therapy had a more favorable dosimetric profile than IMRT or adaptive IMRT and may obviate the need for adaptive planning. Protons allowed significant sparing of the spinal cord, parotid glands, larynx, and brainstem and should be considered for SCCHN to decrease normal tissue toxicity while still providing optimal tumor coverage.
| S-EPMC3174314 | biostudies-literature
Project description:Patients undergoing intensity-modulated radiotherapy (IMRT) for head and neck cancer may have increased incidence of dry eye disease and the exact mechanism is unclear. The present study aims to assess tear film and meibomian gland (MG) features in patients who received IMRT for head and neck cancer not involving the orbital area. Twenty-seven patients (64.7 ± 9.8 years) and 30 age-matched controls (61.4 ± 11.0 years) underwent a comprehensive dry eye work-up. Compared to the control group, the patients had more lid margin abnormalities, and worse meibum quality. The MG loss, calculated as (tarsal area-MG area)/tarsal area, was higher in the patient group in both the upper (53.0 ± 12.0% vs. 35.1 ± 10.3%, p < 0.001) and lower lids (69.5 ± 12.6% vs. 48.5 ± 12.5%, p < 0.001). In the patient group, more MG loss in the lower lids correlated with worse meibum quality (r = 0.445, p = 0.029). In contrast, there was no significant difference in aqueous tear production level, measured with Schirmer test. Patients treated with IMRT for head and neck cancer seemed to have comparable lacrimal gland function to the controls despite more dry eye symptoms. However, the patients had MG functional and morphological changes, which may present a higher risk for developing dry eye disease.
| S-EPMC8599465 | biostudies-literature
Project description:ImportanceThe majority of the patients with head and neck cancer (HNC) experience taste dysfunction (TD) during or after radiotherapy (RT). However, prospectively collected data for taste dysfunction have been limited, especially in the era of intensity-modulated RT (IMRT).ObjectiveTo evaluate the taste function in patients with HNC receiving IMRT by investigating the association between time course and recovery of TD in both acute and late phases.Design, setting, and participantsFrom August 2017 to November 2020, patients treated at the Chang Gung Memorial Hospital with curative or postoperative IMRT for HNC were enrolled in this prospective cohort study. The data analysis was performed from March 2021 to January 2022.ExposuresIMRT with and without concurrent chemotherapy.Main outcomes and measuresTaste function was measured using the whole-mouth solution method for 4 tastes (salt, sweet, sour, and bitter). Subjective evaluations (National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.03] and Subjective Total Taste Acuity scale) were used. Patient self-reported quality of life was evaluated using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N35).ResultsA total of 87 patients (78 [90%] men and 9 [10%] women; mean [range] age, 58 [31-80] years) were enrolled. Overall TD rates were 79 of 86 (91.9%), 63 of 83 (75.9%), 27 of 81 (33.3%), 5 of 56 (8.9%), and 2 of 30 (6.7%) during RT, and 1 week, 3 months, 6 months, and 1 year after RT, respectively. Positive correlation occurred between objectively measured taste loss for the 4 taste qualities and subjective perception of taste loss. Only oral cavity mean dose 4000 cGy or greater predicted TD 3 months after RT. The mean oral cavity doses to the predicted 15% (D15), 25% (D25), and 50% (D50) probabilities were 25, 38, and 60 Gy at 3 months and 57, 60, and 64 Gy at 6 months, respectively.Conclusions and relevanceIn this cohort study, most patients still experienced TD during and at 3 months after RT. Only a few patients experienced long-term TD. A high oral cavity dose was associated with TD in patients with HNC receiving IMRT. Reducing oral cavity dose may promote early recovery of taste function after IMRT.
| S-EPMC9136673 | biostudies-literature