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Strahlentherapie und Onkologie

Published in:

01-02-2019 | Original Article

A density assignment method for dose monitoring in head-and-neck radiotherapy

Authors: A. Barateau, N. Perichon, J. Castelli, U. Schick, O. Henry, E. Chajon, A. Simon, C. Lafond, R. De Crevoisier

Published in: Strahlentherapie und Onkologie | Issue 2/2019

Abstract

Background and purpose

During head-and-neck (H&N) radiotherapy, the parotid glands (PGs) may be overdosed; thus, a tool is required to monitor the delivered dose. This study aimed to assess the dose accuracy of a patient-specific density assignment method (DAM) for dose calculation to monitor the dose to PGs during treatment.

Patients and methods

Forty patients with H&N cancer received an intensity modulated radiation therapy (IMRT), among whom 15 had weekly CTs. Dose distributions were calculated either on the CTs (CT_ref), on one-class CTs (1C-CT, water), or on three-class CTs (3C-CT, water-air-bone). The inter- and intra-patient DAM uncertainties were evaluated by the difference between doses calculated on CT_ref and 1C-CTs or 3C-CTs. PG mean dose (D_mean) and spinal cord maximum dose (D_2%) were considered. The cumulated dose to the PGs was estimated by the mean D_mean of the weekly CTs.

Results

The mean (maximum) inter-patient DAM dose uncertainties for the PGs (in cGy) were 23 (75) using 1C-CTs and 12 (50) using 3C-CTs (p ≤ 0.001). For the spinal cord, these uncertainties were 118 (245) and 15 (67; p ≤ 0.001). The mean (maximum) DAM dose uncertainty between cumulated doses calculated on CTs and 3C-CTs was 7 cGy (45 cGy) for the PGs. Considering the difference between the planned and cumulated doses, 53% of the ipsilateral and 80% of the contralateral PGs were overdosed by +3.6 Gy (up to 8.2 Gy) and +1.9 Gy (up to 5.2 Gy), respectively.

Conclusion

The uncertainty of the three-class DAM appears to be clinically non-significant (<0.5 Gy) compared with the PG overdose (up to 8.2 Gy). This DAM could therefore be used to monitor PG doses and trigger replanning.

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Barker JL, Garden AS, Ang KK, O’Danierl JC, Wang H, Court LE (2004) Quantification of volumetric and geometric changes occurring during fractionated radiotherapy for head-and-neck cancer using an integrated CT/linear accelerator system. Int J Radiat Oncol Biol Phys 59:960–970CrossRefPubMed

Nishi T, Nishimura Y, Shibata T, Tamura M, Nishigaito N, Okumura M (2013) Volume and dosimetric changes and initial clinical experience of a two-step adaptive intensity modulated radiation therapy (IMRT) scheme for head and neck cancer. Radiother Oncol 106:85–89CrossRefPubMed

Marzi S, Pinnaro P, D’Alessio D, Strigari L, Bruzzaniti V, Giordano C (2012) Anatomical and dose changes of gross tumour volume and parotid glands for head and neck cancer patients during intensity-modulated radiotherapy: effect on the probability of xerostomia incidence. Clin Oncol 24:e54–e62CrossRef

Castelli J, Simon A, Rigaud B, Lafond C, Chajon E, Ospina JD (2016) A nomogram to predict parotid gland overdose in head and neck IMRT. Radiat Oncol. https://doi.org/10.1186/s13014-016-0650-6 CrossRefPubMedPubMedCentral

Duma MN, Kampfer S, Schuster T, Winkler C, Geinitz H (2012) Adaptive radiotherapy for soft tissue changes during helical tomotherapy for head and neck cancer. Strahlenther Onkol 188:243–247CrossRefPubMed

Brouwer CL, Steenbakkers RJHM, Langendijk JA, Sijtsema NM (2015) Identifying patients who may benefit from adaptive radiotherapy: Does the literature on anatomic and dosimetric changes in head and neck organs at risk during radiotherapy provide information to help? Radiother Oncol 115:285–294CrossRefPubMed

Zhang P, Simon A, Rigaud B, Castelli J, Ospina Arango JD, Nassef M (2016) Optimal adaptive IMRT strategy to spare the parotid glands in oropharyngeal cancer. Radiother Oncol 120:41–47CrossRefPubMed

Veiga C, McClelland J, Moinuddin S, Lourenço A, Ricketts K, Annkah J (2014) Toward adaptive radiotherapy for head and neck patients: feasibility study on using CT-to-CBCT deformable registration for ‘dose of the day’ calculations. Med Phys. https://doi.org/10.1118/1.4864240 CrossRefPubMed

Elstrøm UV, Muren LP, Petersen JBB, Grau C (2011) Evaluation of image quality for different kV cone-beam CT acquisition and reconstruction methods in the head and neck region. Acta Oncol 50:908–917CrossRefPubMed

10.

Gardner SJ, Studenski MT, Giaddui T, Cui Y, Galvin J, Yu Y (2014) Investigation into image quality and dose for different patient geometries with multiple cone-beam CT systems. Med Phys. https://doi.org/10.1118/1.4865788 CrossRefPubMedPubMedCentral

11.

Fotina I, Hopfgartner J, Stock M, Steininger T, Lütgendorf-Caucig C, Georg D (2012) Feasibility of CBCT-based dose calculation: comparative analysis of HU adjustment techniques. Radiother Oncol 104:249–256CrossRefPubMed

12.

Dunlop A, McQuaid D, Nill S, Murray J, Poludniowski G, Hansen VN (2015) Comparison of CT number calibration techniques for CBCT-based dose calculation. Strahlenther Onkol 191:970–978CrossRefPubMedPubMedCentral

13.

Brouwer CL, Steenbakkers RJHM, Langendijk JA, Sijtsema NM (2015) CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol 117:83–90CrossRefPubMed

14.

Toledano I, Graff P, Serre A, Boisselier P, Bensadoun RJ, Ortholan C (2012) Intensity-modulated radiotherapy in head and neck cancer: results of the prospective study GORTEC 2004–03. Radiother Oncol 103:57–62CrossRefPubMed

15.

Low DA, Harms WB, Mutic S, Purdy JA (1998) A technique for the quantitative evaluation of dose distributions. Med Phys 25:656–661CrossRefPubMed

16.

Hussein M, Clark CH, Nisbet A (2017) Challenges in calculation of the gamma index in radiotherapy – towards good practice. Phys Med 36:1–11CrossRefPubMed

17.

Guan H, Dong H (2009) Dose calculation accuracy using cone-beam CT (CBCT) for pelvic adaptive radiotherapy. Phys Med Biol 54:6239–6250CrossRefPubMed

18.

Hatton J, McCurdy B, Greer PB (2009) Cone beam computerized tomography: the effect of calibration of the Hounsfield unit number to electron density on dose calculation accuracy for adaptive radiation therapy. Phys Med Biol 54:N329–N346CrossRefPubMed

19.

Thomas SJ (1999) Relative electron density calibration of CT scanners for radiotherapy treatment planning. Br J Radiol 72:781–786CrossRefPubMed

20.

Cozzi L, Fogliata A, Buffa F, Bieri S (1998) Dosimetric impact of computed tomography calibration on a commercial treatment planning system for external radiation therapy. Radiother Oncol 48:335–338CrossRefPubMed

21.

Schulze R (2011) Artefacts in CBCT: a review. Dentomaxillofac Radiol 40:265–273CrossRefPubMedPubMedCentral

22.

Richter A, Hu Q, Steglich D, Baier K, Wilbert J, Guckenberger M, Flentje M (2008) Investigation of the usability of conebeam CT data sets for dose calculation. Radiat Oncol. https://doi.org/10.1186/1748-717x-3-42 CrossRefPubMedPubMedCentral

23.

van Zijtveld M, Dirkx M, Heijmen B (2007) Correction of conebeam CT values using a planning CT for derivation of the ’dose of the day. Radiother Oncol 85:195–200CrossRefPubMed

24.

Ho KF, Marchant T, Moore C, Webster G, Rowbottom C, Penington H (2012) Monitoring dosimetric impact of weight loss with kilovoltage (KV) cone beam CT (CBCT) during parotid-sparing IMRT and concurrent chemotherapy. Int J Radiat Oncol Biol Phys 82:e375–e382CrossRefPubMed

25.

Onozato Y, Kadoya N, Fujita Y, Arai K, Dobashi S, Takeda K (2014) Evaluation of on-board kV cone beam computed tomography–based dose calculation with deformable image registration using Hounsfield unit modifications. Int J Radiat Oncol Biol Phys 89:416–423CrossRefPubMed

26.

Disher B, Hajdok G, Wang A, Craig J, Gaede S, Battista JJ (2013) Correction for ‘artificial’ electron disequilibrium due to cone-beam CT density errors: implications for on-line adaptive stereotactic body radiation therapy of lung. Phys Med Biol 58:4157–4174CrossRefPubMed

27.

Karotki A, Mah K, Meijer G, Meltsner M (2011) Comparison of bulk electron density and voxel-based electron density treatment planning. J Appl Clin Med Phys 12:97–104CrossRefPubMedCentral

28.

Marchant TE, Joshi KD, Moore CJ (2018) Accuracy of radiotherapy dose calculations based on cone-beam CT: comparison of deformable registration and image correction based methods. Phys Med Biol. https://doi.org/10.1088/1361-6560/aab0f0 CrossRefPubMed

29.

Brivio D, Hu YD, Margalit DN, Zygmanski P (2018) Selection of head and neck cancer patients for adaptive replanning of radiation treatment using kV-CBCT. Biomed Phys Eng Express. https://doi.org/10.1088/2057-1976/aad546 CrossRef

30.

Rigaud B, Simon A, Castelli J, Gobeli M, Ospina Arango JD, Cazoulat G (2015) Evaluation of deformable image registration methods for dose monitoring in head and neck radiotherapy. Biomed Res Int. https://doi.org/10.1155/2015/726268 CrossRefPubMedPubMedCentral

31.

Pukala J, Johnson PB, Shah AP, Langen KM, Bova FJ, Staton RB (2016) Benchmarking of five commercial deformable image registration algorithms for head and neck patients. J Appl Clin Med Phys 17:25–40CrossRefPubMedPubMedCentral

32.

Castadot P, Lee JA, Parraga A, Geets X, Macq B, Grégoire V (2008) Comparison of 12 deformable registration strategies in adaptive radiation therapy for the treatment of head and neck tumors. Radiother Oncol 89:1–12CrossRefPubMed

33.

Li X, Zhang Y, Shi Y, Wu S, Xiao Y, Gu X (2017) Comprehensive evaluation of ten deformable image registration algorithms for contour propagation between CT and cone-beam CT images in adaptive head & neck radiotherapy. PLoS ONE 12:e175906CrossRefPubMedPubMedCentral

34.

La Macchia M, Fellin F, Amichetti M, Cianchetti M, Gianolini S, Paola V (2012) Systematic evaluation of three different commercial software solutions for automatic segmentation for adaptive therapy in head-and-neck, prostate and pleural cancer. Radiat Oncol 7:160CrossRefPubMedPubMedCentral

35.

Hou J, Guerrero M, Chen W, D’Souza WD (2011) Deformable planning CT to cone-beam CT image registration in head-and-neck cancer. Med Phys. https://doi.org/10.1118/1.3554647 CrossRefPubMed

36.

Elstrøm UV, Wysocka BA, Muren LP, Petersen JBB, Grau C (2010) Daily kV cone-beam CT and deformable image registration as a method for studying dosimetric consequences of anatomic changes in adaptive IMRT of head and neck cancer. Acta Oncol 49:1101–1108CrossRefPubMed

37.

Hvid CA, Elstrøm UV, Jensen K, Alber M, Grau C (2016) Accuracy of software-assisted contour propagation from planning CT to cone beam CT in head and neck radiotherapy. Acta Oncol 55:1324–1330CrossRefPubMed

Title: A density assignment method for dose monitoring in head-and-neck radiotherapy
Authors: A. Barateau
N. Perichon
J. Castelli
U. Schick
O. Henry
E. Chajon
A. Simon
C. Lafond
R. De Crevoisier
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 2/2019
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-018-1379-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A density assignment method for dose monitoring in head-and-neck radiotherapy

Abstract

Background and purpose

Patients and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background and purpose

Patients and methods

Results

Conclusion

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