Three-dimensional dose evaluation in breast cancer patients to define decision criteria for adaptive radiotherapy

Catharina M L Zegers; Jose A Baeza; Wouter van Elmpt; Lars H P Murrer; Karolien Verhoeven; Liesbeth Boersma; Frank Verhaegen; Sebastiaan M J J G Nijsten

doi:10.1080/0284186X.2017.1349334

Three-dimensional dose evaluation in breast cancer patients to define decision criteria for adaptive radiotherapy

Catharina M L Zegers^*, Jose A Baeza, Wouter van Elmpt, Lars H P Murrer, Karolien Verhoeven, Liesbeth Boersma, Frank Verhaegen, Sebastiaan M J J G Nijsten

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Dose-guided adaptive radiation therapy (DGART) is the systematic evaluation and adaptation of the dose delivery during treatment for an individual patient. The aim of this study is to define quantitative action levels for DGART by evaluating changes in 3D dose metrics in breast cancer and correlate them with clinical expert evaluation.

Material and methods: Twenty-three breast cancer treatment plans were evaluated, that were clinically adapted based on institutional IGRT guidelines. Reasons for adaptation were variation in seroma, hematoma, edema, positioning or problems using voluntary deep inspiration breath hold. Sixteen patients received a uniform dose to the breast (clinical target volume 1; CTV1). Six patients were treated with a simultaneous integrated boost to CTV2. The original plan was copied to the CT during treatment (re-CT) or to the stitched cone-beam CT (CBCT). Clinical expert evaluation of the re-calculated dose distribution and extraction of dose-volume histogram (DVH) parameters were performed. The extreme scenarios were evaluated, assuming all treatment fractions were given to the original planning CT (pCT), re-CT or CBCT. Reported results are mean +/- SD.

Results: DVH results showed a mean dose (Dmean) difference between pCT and re-CT of -0.4 +/- 1.4% (CTV1) and -1.4 +/- 2.1% (CTV2). The difference in V95% was -2.6 +/- 4.4% (CTV1) and -9.8 +/- 8.3% (CTV2). Clinical evaluation and DVH evaluation resulted in a recommended adaptation in 17/23 or 16/23 plans, respectively. Applying thresholds on the DVH parameters: Dmean CTV, V95% CTV, Dmax, mean lung dose, volume exceeding 107% (uniform dose) or 90% (SIB) of the prescribed dose enabled the identification of patients with an assumed clinically relevant dose difference, with a sensitivity of 0.89 and specificity of 1.0. Re-calculation on CBCT imaging identified the same plans for adaptation as re-CT imaging.

Conclusions: Clinical expert evaluation can be related to quantitative DVH parameters on re-CT or CBCT imaging to select patients for DGART.

Original language	English
Pages (from-to)	1487-1494
Number of pages	8
Journal	Acta Oncologica
Volume	56
Issue number	11
DOIs	https://doi.org/10.1080/0284186X.2017.1349334
Publication status	Published - Nov 2017
Event	15th Acta Oncologica Symposium - Biology-Guided Adaptive Radiotherapy (BiGART) - Aarhus, Denmark Duration: 13 Jun 2017 → 16 Jun 2017

Keywords

Breast Neoplasms/radiotherapy
Cone-Beam Computed Tomography/methods
Decision Support Techniques
Female
Humans
Image Processing, Computer-Assisted/methods
Imaging, Three-Dimensional/methods
Organs at Risk/radiation effects
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted/methods
Radiotherapy, Intensity-Modulated/methods
Retrospective Studies

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Cite this

@article{32d78741e2cc4dd2b9ff5166bff0f381,

title = "Three-dimensional dose evaluation in breast cancer patients to define decision criteria for adaptive radiotherapy",

abstract = "Background: Dose-guided adaptive radiation therapy (DGART) is the systematic evaluation and adaptation of the dose delivery during treatment for an individual patient. The aim of this study is to define quantitative action levels for DGART by evaluating changes in 3D dose metrics in breast cancer and correlate them with clinical expert evaluation.Material and methods: Twenty-three breast cancer treatment plans were evaluated, that were clinically adapted based on institutional IGRT guidelines. Reasons for adaptation were variation in seroma, hematoma, edema, positioning or problems using voluntary deep inspiration breath hold. Sixteen patients received a uniform dose to the breast (clinical target volume 1; CTV1). Six patients were treated with a simultaneous integrated boost to CTV2. The original plan was copied to the CT during treatment (re-CT) or to the stitched cone-beam CT (CBCT). Clinical expert evaluation of the re-calculated dose distribution and extraction of dose-volume histogram (DVH) parameters were performed. The extreme scenarios were evaluated, assuming all treatment fractions were given to the original planning CT (pCT), re-CT or CBCT. Reported results are mean +/- SD.Results: DVH results showed a mean dose (Dmean) difference between pCT and re-CT of -0.4 +/- 1.4% (CTV1) and -1.4 +/- 2.1% (CTV2). The difference in V95% was -2.6 +/- 4.4% (CTV1) and -9.8 +/- 8.3% (CTV2). Clinical evaluation and DVH evaluation resulted in a recommended adaptation in 17/23 or 16/23 plans, respectively. Applying thresholds on the DVH parameters: Dmean CTV, V95% CTV, Dmax, mean lung dose, volume exceeding 107% (uniform dose) or 90% (SIB) of the prescribed dose enabled the identification of patients with an assumed clinically relevant dose difference, with a sensitivity of 0.89 and specificity of 1.0. Re-calculation on CBCT imaging identified the same plans for adaptation as re-CT imaging.Conclusions: Clinical expert evaluation can be related to quantitative DVH parameters on re-CT or CBCT imaging to select patients for DGART.",

keywords = "Breast Neoplasms/radiotherapy, Cone-Beam Computed Tomography/methods, Decision Support Techniques, Female, Humans, Image Processing, Computer-Assisted/methods, Imaging, Three-Dimensional/methods, Organs at Risk/radiation effects, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted/methods, Radiotherapy, Intensity-Modulated/methods, Retrospective Studies",

author = "Zegers, {Catharina M L} and Baeza, {Jose A} and {van Elmpt}, Wouter and Murrer, {Lars H P} and Karolien Verhoeven and Liesbeth Boersma and Frank Verhaegen and Nijsten, {Sebastiaan M J J G}",

year = "2017",

month = nov,

doi = "10.1080/0284186X.2017.1349334",

language = "English",

volume = "56",

pages = "1487--1494",

journal = "Acta Oncologica",

issn = "0284-186X",

publisher = "Routledge/Taylor & Francis Group",

number = "11",

note = "15th Acta Oncologica Symposium - Biology-Guided Adaptive Radiotherapy (BiGART) ; Conference date: 13-06-2017 Through 16-06-2017",

}

TY - JOUR

T1 - Three-dimensional dose evaluation in breast cancer patients to define decision criteria for adaptive radiotherapy

AU - Zegers, Catharina M L

AU - Baeza, Jose A

AU - van Elmpt, Wouter

AU - Murrer, Lars H P

AU - Verhoeven, Karolien

AU - Boersma, Liesbeth

AU - Verhaegen, Frank

AU - Nijsten, Sebastiaan M J J G

PY - 2017/11

Y1 - 2017/11

N2 - Background: Dose-guided adaptive radiation therapy (DGART) is the systematic evaluation and adaptation of the dose delivery during treatment for an individual patient. The aim of this study is to define quantitative action levels for DGART by evaluating changes in 3D dose metrics in breast cancer and correlate them with clinical expert evaluation.Material and methods: Twenty-three breast cancer treatment plans were evaluated, that were clinically adapted based on institutional IGRT guidelines. Reasons for adaptation were variation in seroma, hematoma, edema, positioning or problems using voluntary deep inspiration breath hold. Sixteen patients received a uniform dose to the breast (clinical target volume 1; CTV1). Six patients were treated with a simultaneous integrated boost to CTV2. The original plan was copied to the CT during treatment (re-CT) or to the stitched cone-beam CT (CBCT). Clinical expert evaluation of the re-calculated dose distribution and extraction of dose-volume histogram (DVH) parameters were performed. The extreme scenarios were evaluated, assuming all treatment fractions were given to the original planning CT (pCT), re-CT or CBCT. Reported results are mean +/- SD.Results: DVH results showed a mean dose (Dmean) difference between pCT and re-CT of -0.4 +/- 1.4% (CTV1) and -1.4 +/- 2.1% (CTV2). The difference in V95% was -2.6 +/- 4.4% (CTV1) and -9.8 +/- 8.3% (CTV2). Clinical evaluation and DVH evaluation resulted in a recommended adaptation in 17/23 or 16/23 plans, respectively. Applying thresholds on the DVH parameters: Dmean CTV, V95% CTV, Dmax, mean lung dose, volume exceeding 107% (uniform dose) or 90% (SIB) of the prescribed dose enabled the identification of patients with an assumed clinically relevant dose difference, with a sensitivity of 0.89 and specificity of 1.0. Re-calculation on CBCT imaging identified the same plans for adaptation as re-CT imaging.Conclusions: Clinical expert evaluation can be related to quantitative DVH parameters on re-CT or CBCT imaging to select patients for DGART.

AB - Background: Dose-guided adaptive radiation therapy (DGART) is the systematic evaluation and adaptation of the dose delivery during treatment for an individual patient. The aim of this study is to define quantitative action levels for DGART by evaluating changes in 3D dose metrics in breast cancer and correlate them with clinical expert evaluation.Material and methods: Twenty-three breast cancer treatment plans were evaluated, that were clinically adapted based on institutional IGRT guidelines. Reasons for adaptation were variation in seroma, hematoma, edema, positioning or problems using voluntary deep inspiration breath hold. Sixteen patients received a uniform dose to the breast (clinical target volume 1; CTV1). Six patients were treated with a simultaneous integrated boost to CTV2. The original plan was copied to the CT during treatment (re-CT) or to the stitched cone-beam CT (CBCT). Clinical expert evaluation of the re-calculated dose distribution and extraction of dose-volume histogram (DVH) parameters were performed. The extreme scenarios were evaluated, assuming all treatment fractions were given to the original planning CT (pCT), re-CT or CBCT. Reported results are mean +/- SD.Results: DVH results showed a mean dose (Dmean) difference between pCT and re-CT of -0.4 +/- 1.4% (CTV1) and -1.4 +/- 2.1% (CTV2). The difference in V95% was -2.6 +/- 4.4% (CTV1) and -9.8 +/- 8.3% (CTV2). Clinical evaluation and DVH evaluation resulted in a recommended adaptation in 17/23 or 16/23 plans, respectively. Applying thresholds on the DVH parameters: Dmean CTV, V95% CTV, Dmax, mean lung dose, volume exceeding 107% (uniform dose) or 90% (SIB) of the prescribed dose enabled the identification of patients with an assumed clinically relevant dose difference, with a sensitivity of 0.89 and specificity of 1.0. Re-calculation on CBCT imaging identified the same plans for adaptation as re-CT imaging.Conclusions: Clinical expert evaluation can be related to quantitative DVH parameters on re-CT or CBCT imaging to select patients for DGART.

KW - Breast Neoplasms/radiotherapy

KW - Cone-Beam Computed Tomography/methods

KW - Decision Support Techniques

KW - Female

KW - Humans

KW - Image Processing, Computer-Assisted/methods

KW - Imaging, Three-Dimensional/methods

KW - Organs at Risk/radiation effects

KW - Radiotherapy Dosage

KW - Radiotherapy Planning, Computer-Assisted/methods

KW - Radiotherapy, Intensity-Modulated/methods

KW - Retrospective Studies

U2 - 10.1080/0284186X.2017.1349334

DO - 10.1080/0284186X.2017.1349334

M3 - Article

C2 - 28849731

SN - 0284-186X

VL - 56

SP - 1487

EP - 1494

JO - Acta Oncologica

JF - Acta Oncologica

IS - 11

T2 - 15th Acta Oncologica Symposium - Biology-Guided Adaptive Radiotherapy (BiGART)

Y2 - 13 June 2017 through 16 June 2017

ER -