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Article ; Online: MR-guided stereotactic radiation therapy for head and neck cancers.

Wang, He / Yang, Jinzhong / Lee, Anna / Phan, Jack / Lim, Tze Yee / Fuller, Clifton D / Han, Eun Young / Rhee, Dong Joo / Salzillo, Travis / Zhao, Yao / Chopra, Nitish / Pham, Mary / Castillo, Pam / Sobremonte, Angela / Moreno, Amy C / Reddy, Jay P / Rosenthal, David / Garden, Adam S / Wang, Xin

Clinical and translational radiation oncology

2024 Volume 46, Page(s) 100760

Abstract: Purpose: MR-guided radiotherapy (MRgRT) has the advantage of utilizing high soft tissue contrast imaging to track daily changes in target and critical organs throughout the entire radiation treatment course. Head and neck (HN) stereotactic body ... ...

Abstract	Purpose: MR-guided radiotherapy (MRgRT) has the advantage of utilizing high soft tissue contrast imaging to track daily changes in target and critical organs throughout the entire radiation treatment course. Head and neck (HN) stereotactic body radiation therapy (SBRT) has been increasingly used to treat localized lesions within a shorter timeframe. The purpose of this study is to examine the dosimetric difference between the step-and-shot intensity modulated radiation therapy (IMRT) plans on Elekta Unity and our clinical volumetric modulated arc therapy (VMAT) plans on Varian TrueBeam for HN SBRT. Method: Fourteen patients treated on TrueBeam sTx with VMAT treatment plans were re-planned in the Monaco treatment planning system for Elekta Unity MR-Linac (MRL). The plan qualities, including target coverage, conformity, homogeneity, nearby critical organ doses, gradient index and low dose bath volume, were compared between VMAT and Monaco IMRT plans. Additionally, we evaluated the Unity adaptive plans of adapt-to-position (ATP) and adapt-to-shape (ATS) workflows using simulated setup errors for five patients and assessed the outcomes of our treated patients. Results: Monaco IMRT plans achieved comparable results to VMAT plans in terms of target coverage, uniformity and homogeneity, with slightly higher target maximum and mean doses. The critical organ doses in Monaco IMRT plans all met clinical goals; however, the mean doses and low dose bath volumes were higher than in VMAT plans. The adaptive plans demonstrated that the ATP workflow may result in degraded target coverage and OAR doses for HN SBRT, while the ATS workflow can maintain the plan quality. Conclusion: The use of Monaco treatment planning and online adaptation can achieve dosimetric results comparable to VMAT plans, with the additional benefits of real-time tracking of target volume and nearby critical structures. This offers the potential to treat aggressive and variable tumors in HN SBRT and improve local control and treatment toxicity.
Language	English
Publishing date	2024-03-07
Publishing country	Ireland
Document type	Journal Article
ISSN	2405-6308
ISSN (online)	2405-6308
DOI	10.1016/j.ctro.2024.100760
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Article ; Online: Dose accumulation of daily adaptive plans to decide optimal plan adaptation strategy for head-and-neck patients treated with MR-Linac.

Lim, Shin Yun / Tran, Alan / Tran, Anh Ngoc Kieu / Sobremonte, Angela / Fuller, Clifton D / Simmons, Lori / Yang, Jinzhong

Medical dosimetry : official journal of the American Association of Medical Dosimetrists

2021 Volume 47, Issue 1, Page(s) 103–109

Abstract: Advances in magnetic resonance linear accelerators (MR-Linacs) allow for superior visualization of soft tissue to guide online adaptive replanning for precise radiotherapy delivery. Elekta Unity MR-Linacs (Elekta AB, Stockholm, Sweden) provides 2 plan ... ...

Abstract	Advances in magnetic resonance linear accelerators (MR-Linacs) allow for superior visualization of soft tissue to guide online adaptive replanning for precise radiotherapy delivery. Elekta Unity MR-Linacs (Elekta AB, Stockholm, Sweden) provides 2 plan adaptation approaches, adapt-to-position (ATP), plan reoptimization based on the reference CT with the iso-shift measured from daily MR scans, and adapt-to-shape (ATS), full plan reoptimization based on the re-contoured daily MR scans. Our study aims to close the gap in knowledge regarding the use of the ATP technique in the treatment of head and neck (HN) cancers through the analysis of accumulated dose of daily ATP plans to organs at risk (OARs). Daily accumulated doses of 8 HN patients using deformable registration were analyzed to estimate the actual delivered dose versus the planned dose to evaluate the impact from daily anatomical changes and setup uncertainties. This process was completed through the collection of doses to OARs which were chosen based on the rigidity and size of the organ and the substantial dose it received. Results showed that the actual dose delivered to some OARs was significantly higher than the originally planned dose and was more pronounced in structures that were within the high-dose gradient for some subdisease sites. These findings suggest that the ATS approach should be used for plan adaptation in some specific HN diseases where OARs receive substantial dose with anatomy changes that could not be accounted for by the ATP approach. We also investigated the possibility of predicting the actual delivered dose at an early stage of the treatment course, with the intention of exploring a possibly more optimal alternative for planning through the combination of ATP and ATS approaches throughout treatment.
MeSH term(s)	Humans ; Magnetic Resonance Imaging ; Organs at Risk ; Particle Accelerators ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated
Language	English
Publishing date	2021-10-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	645065-9
ISSN	1873-4022 ; 0958-3947 ; 0739-0211
ISSN (online)	1873-4022
ISSN	0958-3947 ; 0739-0211
DOI	10.1016/j.meddos.2021.08.005
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Zs.A 2448: Show issues

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Article ; Online: Clinical Implementation and Initial Experience With a 1.5 Tesla MR-Linac for MR-Guided Radiation Therapy for Gynecologic Cancer: An R-IDEAL Stage 1 and 2a First in Humans Feasibility Study of New Technology Implementation.

Lakomy, David S / Yang, Jinzhong / Vedam, Sastry / Wang, Jihong / Lee, Belinda / Sobremonte, Angela / Castillo, Pamela / Hughes, Neil / Mohammedsaid, Mustefa / Jhingran, Anuja / Klopp, Ann H / Choi, Seungtaek / Fuller, C David / Lin, Lilie L

Practical radiation oncology

2022 Volume 12, Issue 4, Page(s) e296–e305

Abstract: Purpose: Magnetic resonance imaging-guided linear accelerator systems (MR-linacs) can facilitate the daily adaptation of radiation therapy plans. Here, we report our early clinical experience using a MR-linac for adaptive radiation therapy of ... ...

Abstract	Purpose: Magnetic resonance imaging-guided linear accelerator systems (MR-linacs) can facilitate the daily adaptation of radiation therapy plans. Here, we report our early clinical experience using a MR-linac for adaptive radiation therapy of gynecologic malignancies. Methods and materials: Treatments were planned with an Elekta Monaco v5.4.01 and delivered by a 1.5 Tesla Elekta Unity MR-linac. The system offers a choice of daily adaptation based on either position (ATP) or shape (ATS) of the tumor and surrounding normal structures. The ATS approach has the option of manually editing the contours of tumors and surrounding normal structures before the plan is adapted. Here, we documented the duration of each treatment fraction; set-up variability (assessed by isocenter shifts in each plan) between fractions; and, for quality assurance, calculated the percentage of plans meeting the γ-criterion of 3%/3-mm distance to agreement. Deformable accumulated dose calculations were used to compare accumulated versus planned dose for patient treated with exclusively ATP fractions. Results: Of the 10 patients treated with 90 fractions on the MR-linac, most received boost doses to recurrence in nodes or isolated tumors. Each treatment fraction lasted a median 32 minutes; fractions were shorter with ATP than with ATS (30 min vs 42 min, P < .0001). The γ criterion for all fraction plans exceeded >90% (median, 99.9%; range, 92.4%-100%; ie, all plans passed quality assurance testing). The average extent of isocenter shift was <0.5 cm in each axis. The accumulated dose to the gross tumor volume was within 5% of the reference plan for all ATP cases. Accumulated doses for lesions in the pelvic periphery were within <1% of the reference plan as opposed to -1.6% to -4.4% for central pelvic tumors. Conclusions: The MR-linac is a reliable and clinically feasible tool for treating patients with gynecologic cancer.
MeSH term(s)	Adenosine Triphosphate ; Feasibility Studies ; Female ; Genital Neoplasms, Female/radiotherapy ; Humans ; Magnetic Resonance Imaging/methods ; Particle Accelerators ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Technology
Chemical Substances	Adenosine Triphosphate (8L70Q75FXE)
Language	English
Publishing date	2022-03-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2655748-4
ISSN	1879-8519 ; 1879-8500
ISSN (online)	1879-8519
ISSN	1879-8500
DOI	10.1016/j.prro.2022.03.002
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Article ; Online: Online adaptive planning for prostate stereotactic body radiotherapy using a 1.5 Tesla magnetic resonance imaging-guided linear accelerator.

Yang, Jinzhong / Vedam, Sastry / Lee, Belinda / Castillo, Pamela / Sobremonte, Angela / Hughes, Neil / Mohammedsaid, Mustefa / Wang, Jihong / Choi, Seungtaek

Physics and imaging in radiation oncology

2020 Volume 17, Page(s) 20–24

Abstract: Recent advances in integrating 1.5 Tesla magnetic resonance (MR) imaging with a linear accelerator (MR-Linac) allow MR-guided stereotactic body radiotherapy (SBRT) for prostate cancer. Choosing an optimal strategy for daily online plan adaptation is ... ...

Abstract	Recent advances in integrating 1.5 Tesla magnetic resonance (MR) imaging with a linear accelerator (MR-Linac) allow MR-guided stereotactic body radiotherapy (SBRT) for prostate cancer. Choosing an optimal strategy for daily online plan adaptation is particularly important for MR-guided radiotherapy. We analyzed deformable dose accumulation on scans from four patients and found that daily anatomy changes had little impact on the delivered dose, with the dose to the prostate within 0.5% and dose to the rectum/bladder mostly less than 0.5 Gy. These findings could help in the choice of an optimal strategy for online plan adaptation for MR-guided prostate SBRT.
Language	English
Publishing date	2020-12-24
Publishing country	Netherlands
Document type	Journal Article
ISSN	2405-6316
ISSN (online)	2405-6316
DOI	10.1016/j.phro.2020.12.001
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Article ; Online: Patterns of treatment failure in patients undergoing adjuvant or definitive radiotherapy for vulvar cancer.

Vorbeck, Christina Steen / Jhingran, Anuja / Iyer, Revathy B / Loft, Annika / Klopp, Ann / Mirza, Mansoor Raza / Sobremonte, Angela / Vedam, Sastry / Vogelius, Ivan Richter

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2019

Abstract: Objectives: Knowledge of the detailed pattern of failure can be useful background knowledge in clinical decision making and potentially drive the development of new treatment strategies by increasing radiotherapy dose prescription to high-risk sub- ... ...

Abstract	Objectives: Knowledge of the detailed pattern of failure can be useful background knowledge in clinical decision making and potentially drive the development of new treatment strategies by increasing radiotherapy dose prescription to high-risk sub-regions of the target. Here, we analyze patterns of recurrence in patients with vulvar cancer treated with radiotherapy according to original planning target volumes and radiation dose delivered. Methods: We analyzed dose-planning and post-treatment recurrence scans from patients with vulvar cancer treated at two institutions from January 2009 through October 2014. We delineated the recurrences and merged the dose-planning and recurrence scans for each patient by using deformable co-registration. We estimated the center of each recurrence on the merged scans with the goal of relating them to the original dose plan. Results: We evaluated 157 patients who received radiotherapy for vulvar cancer. Median age was 68 years (range 29-91). Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA-IVB were included. Twenty-nine patients had recurrent disease; 156 patients had squamous cell carcinoma and one patient had adenosquamous carcinoma of the vulva. Among the 157 patients, 37 patients with recurrent disease had recurrence scans available for review, for a total of 80 recurrence sites; 53% of the recurrences were located in the region to which the highest dose (60-70 Gy) had been prescribed. Patients who received definitive radiotherapy developed failure primarily in the high-dose region (80.5%), whereas patients who received adjuvant radiotherapy had a more scattered failure pattern (p<0.0001). Among the latter group, 29.5% failed in the high-dose region. Conclusions: Patients who received definitive versus adjuvant radiotherapy had different failure patterns, indicating that separate approaches are needed to improve both adjuvant and definitive radiotherapy for vulvar cancer.
Language	English
Publishing date	2019-05-23
Publishing country	England
Document type	Journal Article
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2019-000223
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Zs.A 3198: Show issues

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bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: The impact of induction chemotherapy on the dosimetric parameters of subsequent radiotherapy: an investigation of 30 consecutive patients with locally-advanced non-small cell lung cancer and modern radiation planning techniques.

Grant, Jonathan D / Sobremonte, Angela / Hillebrandt, Evangeline / Allen, Pamela K / Gomez, Daniel R

Radiation oncology (London, England)

2015 Volume 10, Page(s) 32

Abstract: Purpose: To investigate the influence of induction chemotherapy (ICT) on dosimetric outcomes in patients with inoperable non-small cell lung cancer (NSCLC) treated with definitive chemoradiation (CRT).: Materials and methods: 30 patients with ... ...

Abstract	Purpose: To investigate the influence of induction chemotherapy (ICT) on dosimetric outcomes in patients with inoperable non-small cell lung cancer (NSCLC) treated with definitive chemoradiation (CRT). Materials and methods: 30 patients with inoperable stage II-III NSCLC treated with 2-4 cycles of ICT followed by definitive CRT to ≥ 60 Gy were selected. Tumor response to chemotherapy was scored by RECIST criteria. Treatment plans based on tumor extent prior to chemotherapy were generated based on equivalent planning constraints and techniques as the original post-chemotherapy plans. Dosimetric parameters predictive of toxicity for lung, esophagus, heart, and spinal cord were compared amongst the pre- and post-ICT plans. Results: The majority of patients (70%) experienced an overall reduction in GTV size between the pre-ICT imaging and the time of simulation. Comparing pre-and post-ICT diagnostic imaging, 5 patients met the RECIST criteria for response, 23 were classified as stable, and 2 experienced disease progression on diagnostic imaging. Despite a significantly reduced GTV size in the post-ICT group, no systematic improvements in normal tissue doses were seen amongst the entire cohort. This result persisted amongst the subgroup of patients with larger pre-ICT GTV tumor volumes (>100 cc(3)). Among patients with RECIST-defined response, a significant reduction in lung mean dose (1.9 Gy absolute, median 18.2 Gy to 16.4 Gy, p = 0.04) and V20, the percentage of lung receiving 20 Gy (3.1% absolute, median 29.3% to 26.3%, p = 0.04) was observed. In the non-responding group of patients, an increased esophageal V50 was found post-chemotherapy (median 28.9% vs 30.1%, p = 0.02). Conclusions: For patients classified as having a response by RECIST to ICT, modest improvements in V20 and mean lung dose were found. However, these benefits were not realized for the cohort as a whole or for patients with larger tumors upfront. Given the variability of tumor response to ICT, the a priori impact of induction chemotherapy to reduce RT dose to normal tissue in these patients is minimal in the setting of modern treatment planning.
MeSH term(s)	Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Carcinoma, Non-Small-Cell Lung/drug therapy ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/radiotherapy ; Carcinoma, Squamous Cell/drug therapy ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/radiotherapy ; Chemoradiotherapy ; Female ; Follow-Up Studies ; Humans ; Induction Chemotherapy ; Lung Neoplasms/drug therapy ; Lung Neoplasms/pathology ; Lung Neoplasms/radiotherapy ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Radiometry/methods ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Intensity-Modulated ; Tumor Burden
Language	English
Publishing date	2015-01-31
Publishing country	England
Document type	Journal Article
ISSN	1748-717X
ISSN (online)	1748-717X
DOI	10.1186/s13014-015-0332-9
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Article ; Online: Initial Feasibility and Clinical Implementation of Daily MR-Guided Adaptive Head and Neck Cancer Radiation Therapy on a 1.5T MR-Linac System: Prospective R-IDEAL 2a/2b Systematic Clinical Evaluation of Technical Innovation.

International journal of radiation oncology, biology, physics

2020 Volume 109, Issue 5, Page(s) 1606–1618

Abstract: Purpose: This prospective study is, to our knowledge, the first report of daily adaptive radiation therapy (ART) for head and neck cancer (HNC) using a 1.5T magnetic resonance imaging-linear accelerator (MR-linac) with particular focus on safety and ... ...

Abstract	Purpose: This prospective study is, to our knowledge, the first report of daily adaptive radiation therapy (ART) for head and neck cancer (HNC) using a 1.5T magnetic resonance imaging-linear accelerator (MR-linac) with particular focus on safety and feasibility and dosimetric results of an online rigid registration-based adapt to position (ATP) workflow. Methods and materials: Ten patients with HNC received daily ART on a 1.5T/7MV MR-linac, 6 using ATP only and 4 using ATP with 1 offline adapt-to-shape replan. Setup variability with custom immobilization masks was assessed by calculating the mean systematic error (M), standard deviation of the systematic error (Σ), and standard deviation of the random error (σ) of the isocenter shifts. Quality assurance was performed with a cylindrical diode array using 3%/3 mm γ criteria. Adaptive treatment plans were summed for each patient to compare the delivered dose with the planned dose from the reference plan. The impact of dosimetric variability between adaptive fractions on the summation plan doses was assessed by tracking the number of optimization constraint violations at each individual fraction. Results: The random errors (mm) for the x, y, and z isocenter shifts, respectively, were M = -0.3, 0.7, 0.1; Σ = 3.3, 2.6, 1.4; and σ = 1.7, 2.9, 1.0. The median (range) γ pass rate was 99.9% (90.9%-100%). The differences between the reference and summation plan doses were -0.61% to 1.78% for the clinical target volume and -11.74% to 8.11% for organs at risk (OARs), although an increase greater than 2% in OAR dose only occurred in 3 cases, each for a single OAR. All cases had at least 2 fractions with 1 or more constraint violations. However, in nearly all instances, constraints were still met in the summation plan despite multiple single-fraction violations. Conclusions: Daily ART on a 1.5T MR-linac using an online ATP workflow is safe and clinically feasible for HNC and results in delivered doses consistent with planned doses.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Dose Fractionation, Radiation ; Feasibility Studies ; Female ; Head and Neck Neoplasms/diagnostic imaging ; Head and Neck Neoplasms/pathology ; Head and Neck Neoplasms/radiotherapy ; Humans ; Immobilization/methods ; Magnetic Resonance Imaging, Interventional ; Male ; Middle Aged ; Organs at Risk/diagnostic imaging ; Prospective Studies ; Radiography, Interventional ; Radiosurgery/instrumentation ; Radiosurgery/methods ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy Setup Errors ; Radiotherapy, Image-Guided/methods ; Time Factors ; Workflow
Language	English
Publishing date	2020-12-16
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2020.12.015
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Article ; Online: MR-guided stereotactic radiation therapy for head and neck cancers.

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Article ; Online: Dose accumulation of daily adaptive plans to decide optimal plan adaptation strategy for head-and-neck patients treated with MR-Linac.

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Article ; Online: Clinical Implementation and Initial Experience With a 1.5 Tesla MR-Linac for MR-Guided Radiation Therapy for Gynecologic Cancer: An R-IDEAL Stage 1 and 2a First in Humans Feasibility Study of New Technology Implementation.

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Article ; Online: Online adaptive planning for prostate stereotactic body radiotherapy using a 1.5 Tesla magnetic resonance imaging-guided linear accelerator.

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Article ; Online: Patterns of treatment failure in patients undergoing adjuvant or definitive radiotherapy for vulvar cancer.

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Article ; Online: The impact of induction chemotherapy on the dosimetric parameters of subsequent radiotherapy: an investigation of 30 consecutive patients with locally-advanced non-small cell lung cancer and modern radiation planning techniques.

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Article ; Online: Initial Feasibility and Clinical Implementation of Daily MR-Guided Adaptive Head and Neck Cancer Radiation Therapy on a 1.5T MR-Linac System: Prospective R-IDEAL 2a/2b Systematic Clinical Evaluation of Technical Innovation.

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