Compliance to radiation therapy of head and neck cancer patients and impact on treatment outcome

The aims of the study were to evaluate head and neck cancer (HNC) patient's compliance to the planned radiation therapy (RT) using the department policy established in 2005 at IPOCFG and to estimate the impact on treatment outcome due to failure in receiving RT as prescribed.info:eu-repo/semantics/publishedVersio

Predicting Xerostomia induced by IMRT treatments: A logistic regression approach

Radiotherapy is one of the main treatments used against cancer. Radiotherapy uses radiation to destroy cancerous cells trying, at the same time, to minimize the damages in healthy tissues. The planning of a radiotherapy treatment is patient dependent, resulting in a lengthy trial and error procedure until a treatment complying as most as possible with the medical prescription is found. Intensity Modulated Radiation Therapy (IMRT) is one technique of radiation treatment that allows the achievement of a high degree of conformity between the area to be treated and the dose absorbed by healthy tissues. Nevertheless, it is still not possible to eliminate completely the potential treatments’ side-effects. In this retrospective study we use the clinical data from patients with head-and-neck cancer treated at the Portuguese Institute of Oncology of Coimbra and explore the possibility of classifying new and untreated patients according to the probability of xerostomia 12 months after the beginning of IMRT treatments by using a logistic regression approach. The results obtained show that the classifier presents a high discriminative ability in predicting the binary response “at risk for xerostomia at 12 months

Estratégia preventiva da mucosite oral em doentes com tumores de cabeça e pescoço. Experiência com fosfato de cálcio

A mucosite oral é uma consequência frequente no tratamento de doentes oncológicos, nomeadamente de cabeça e pescoço. Refere-se a lesões eritematosas e ulcerativas da mucosa oral em doentes submetidos a radioterapia e/ou quimioterapia. Estas lesões são muitas vezes dolorosas e podem comprometer a nutrição, a hidratação, a higiene oral e ainda aumentar o risco de infecção sistémica. Infecções associadas a mucosite oral podem ser a causa de sepsis em doentes imunodeprimidos

SPIDERplan: A tool to support decision-making in radiation therapy treatment plan assessment

Aim In this work, a graphical method for radiotherapy treatment plan assessment and comparison, named SPIDERplan, is proposed. It aims to support plan approval allowing independent and consistent comparisons of different treatment techniques, algorithms or treatment planning systems. Background Optimized plans from modern radiotherapy are not easy to evaluate and compare because of their inherent multicriterial nature. The clinical decision on the best treatment plan is mostly based on subjective options. Materials and methods SPIDERplan combines a graphical analysis with a scoring index. Customized radar plots based on the categorization of structures into groups and on the determination of individual structures scores are generated. To each group and structure, an angular amplitude is assigned expressing the clinical importance defined by the radiation oncologist. Completing the graphical evaluation, a global plan score, based on the structures score and their clinical weights, is determined. After a necessary clinical validation of the group weights, SPIDERplan efficacy, to compare and rank different plans, was tested through a planning exercise where plans had been generated for a nasal cavity case using different treatment planning systems. Results SPIDERplan method was applied to the dose metrics achieved by the nasal cavity test plans. The generated diagrams and scores successfully ranked the plans according to the prescribed dose objectives and constraints and the radiation oncologist priorities, after a necessary clinical validation process. Conclusions SPIDERplan enables a fast and consistent evaluation of plan quality considering all targets and organs at risk.info:eu-repo/semantics/publishedVersio

Assessment and topographic characterization of locoregional recurrences in head and neck tumours

Purpose: To evaluate the differences between three methods of classification of recurrences in patients with head and neck tumours treated with Radiation Therapy (RT). Materials and methods: 367 patients with head and neck tumours were included in the study. Tumour recurrences were delineated in the CT images taken during patient follow-up and deformable registration was used to transfer this volume into the planning CT. The methods used to classify recurrences were: methodCTV quantified the intersection volume between the recurrence and the Clinical Target Volume (CTV); methodTV quantified the intersection between the Treated Volume and the recurrence (for method CTV and TV, recurrences were classified in-field if more than 95% of their volume were inside the volume of interest, marginal if the intersection was between 20-95% and outfield otherwise); and methodCOM was based on the position of the Centre Of Mass of the recurrence. A dose assessment in the recurrence volume was also made. Results: The 2-year Kaplan-Meier locoregional recurrence incidence was 10%. Tumour recurrences occurred in 22 patients in a mean time of 16.5 ± 9.4 months resulting in 28 recurrence volumes. The percentage of in-field recurrences for methods CTV, TV and COM was 7%, 43% and 50%, respectively. Agreement between the three methods in characterizing individually in-field and marginal recurrences was found only in six cases. Methods CTV and COM agreed in 14. The percentage of outfield recurrences was 29% using all methods. For local recurrences (in-field or marginal to gross disease) the average difference between the prescribed dose and D 98% in the recurrence volume was -5.2 ± 3.5% (range: -10.1%-0.9%). Conclusions: The classification of in-field and marginal recurrences is very dependent on the method used to characterize recurrences. Using methods TV and COM the largest percentage of tumour recurrences occurred in-field in tissues irradiated with high doses. Keywords: Head and neck tumours, Radiation therapy, Characterization of tumour recurrences, Geometric methods, Dosimetric assessmen

Biological optimization of angle of incidence and intensity modulation in breast and cervix cancer radiation therapy

Biological treatment optimization aim at improving radiation therapy by accounting for the radiobiological tumour and normal tissues response properties when optimizing the dose delivery. Generally traditional methods, using only dosimetrical measures, disregard the nonlinear radiation response of different tumours and normal tissues. The accumulated knowledge on tissue response to radiation, in the form of more accurate dose response relations, cell survival models and their associated biological parameters, alongside with the tools for biological treatment plan optimization, has allowed the present investigation on the potential merits of biologically based treatment optimization in radiation therapy. With a more widespread implementation of intensity modulated radiation therapy in the clinic, there is an increasing demand for faster and safer treatment delivery techniques. In this thesis biological treatment plan optimization, using the probability to achieve complication free tumour control as the quantifier for treatment outcome, was applied to radiation therapy of early breast cancer and advanced cervix cancer. It is shown that very conformal dose distributions can generally be produced with 3 or 4 optimally orientated coplanar intensity modulated beams, without having clinically significant losses in treatment outcome from the optimal dose distribution. By using exhaustive search methods, the optimal coplanar beam directions for intensity modulated photon beams for early breast cancer and the optimal non-coplanar directions for an advanced cervix cancer were investigated. Although time consuming, exhaustive search methods have the advantage of revealing most features involving interactions between a small number of beams and how this may influence the treatment outcome. Thus phase spaces may serve as a general database for selecting an almost optimal treatment configuration for similar patients. Previous knowledge acquired with physically optimized uniform beam radiation therapy may not apply when intensity modulated biological optimization is used. Thus unconventional treatment directions were sometimes found

SPIDERplan: A tool to support decision-making in radiation therapy treatment plan assessment

AimIn this work, a graphical method for radiotherapy treatment plan assessment and comparison, named SPIDERplan, is proposed. It aims to support plan approval allowing independent and consistent comparisons of different treatment techniques, algorithms or treatment planning systems.BackgroundOptimized plans from modern radiotherapy are not easy to evaluate and compare because of their inherent multicriterial nature. The clinical decision on the best treatment plan is mostly based on subjective options.Materials and methodsSPIDERplan combines a graphical analysis with a scoring index. Customized radar plots based on the categorization of structures into groups and on the determination of individual structures scores are generated. To each group and structure, an angular amplitude is assigned expressing the clinical importance defined by the radiation oncologist. Completing the graphical evaluation, a global plan score, based on the structures score and their clinical weights, is determined. After a necessary clinical validation of the group weights, SPIDERplan efficacy, to compare and rank different plans, was tested through a planning exercise where plans had been generated for a nasal cavity case using different treatment planning systems.ResultsSPIDERplan method was applied to the dose metrics achieved by the nasal cavity test plans. The generated diagrams and scores successfully ranked the plans according to the prescribed dose objectives and constraints and the radiation oncologist priorities, after a necessary clinical validation process.ConclusionsSPIDERplan enables a fast and consistent evaluation of plan quality considering all targets and organs at risk

Comparison of non-coplanar optimization of static beams and arc trajectories for intensity-modulated treatments of meningioma cases

Two methods for non-coplanar beam direction optimization, one for static beams and another for arc trajectories, were proposed for intracranial tumours. The results of the beam angle optimizations were compared with the beam directions used in the clinical plans. Ten meningioma cases already treated were selected for this retrospective planning study. Algorithms for non-coplanar beam angle optimization (BAO) and arc trajectory optimization (ATO) were used to generate the corresponding plans. A plan quality score, calculated by a graphical method for plan assessment and comparison, was used to guide the beam angle optimization process. For each patient, the clinical plans (CLIN), created with the static beam orientations used for treatment, and coplanar VMAT approximated plans (VMAT) were also generated. To make fair plan comparisons, all plan optimizations were performed in an automated multicriteria calculation engine and the dosimetric plan quality was assessed. BAO and ATO plans presented, on average, moderate global plan score improvements over VMAT and CLIN plans. Nevertheless, while BAO and CLIN plans assured a more efficient OARs sparing, the ATO and VMAT plans presented a higher coverage and conformity of the PTV. Globally, all plans presented high-quality dose distributions. No statistically significant quality differences were found, on average, between BAO, ATO and CLIN plans. However, automated plan solution optimizations (BAO or ATO) may improve plan generation efficiency and standardization. In some individual patients, plan quality improvements were achieved with ATO plans, demonstrating the possible benefits of this automated optimized delivery technique

Advantage of Beam Angle Optimization in Head-and-Neck IMRT: Patient Specific Analysis

Radiation therapy (RT) main purpose is to eliminate, in a controlled way, all tumor cells sparing as much as possible the normal tissues. Intensity-Modulated Radiation Therapy (IMRT) is becoming the standard treatment technique in RT. Beam angle optimization (BAO) has potential to confer more quality to IMRT inverse planning process compared to manual trial and error approaches. In this study, the BAO advantages in head-and-neck patients are highlighted, using a patient specific analysis. Fluence optimization was done with Erasmus-iCycle multicriterial engine and BAO optimization was performed using two different algorithms: a combinatorial iterative algorithm and an algorithm based on a pattern search method. Plan assessment and comparison was performed with the graphical tool SPIDERplan. Among a set of forty studied nasopharynx cancer cases, three patients have been select for the specific analysis presented in this work. BAO presented plan quality improvements when beam angular optimized plans were compared with the equidistant beam angle solution and when plans based on non-coplanar beams geometries were compared with coplanar arrangements. Improvement in plan quality with a reduced number of beams was also achieved, in one case. For all cases, BAO generated plans with higher target coverage and better sparing of the normal tissues