scholarly journals Imaging as Part of a Quality Assurance Program: Predictors of Interobserver Variability for Pretreatment Image Registration for Lung SBRT

2019 ◽  
Vol 18 ◽  
pp. 153303381987079
Author(s):  
Geoff Baran ◽  
Jay Burmeister ◽  
Peter Paximadis ◽  
Todd Bossenberg ◽  
Robert Halford ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Image Registration ◽  
Stereotactic Body Radiation Therapy ◽  
Interobserver Variability ◽  
Quality Assurance Program ◽  
P Value ◽  
3 Dimensional ◽  
Stereotactic Body Radiation ◽  
Significant Difference ◽  
Interobserver Variations

Purpose: To evaluate the magnitude of interobserver variability in pretreatment image registration for lung stereotactic body radiation therapy patients in aggregate and within 3 clinical subgroups and to determine methods to identify patients expected to demonstrate larger variability. Methods and Materials: Retrospective image registration was performed for the first and last treatment fraction for 10 lung stereotactic body radiation therapy patients by 16 individual observers (5 physicians, 6 physicists, and 5 therapists). Registration translation values were compared within and between subgroups overall and between the first and the last fractions. Four metrics were evaluated as possible predictors for large interobserver variability. Results: The mean 3-dimensional displacement vector for all patients over all comparisons was 2.4 ± 1.8 mm. Three patients had mean 3-dimensional vector differences >3 mm. This cohort of patients showed a significant interfraction difference in variance ( P value = .01), increasing from first fraction to last. A significant difference in interobserver variability was observed between physicians and physicists ( P value < .01) and therapists and physicists ( P value < .01) but not between physicians and therapists ( P value = .07). Three of the 4 quantities evaluated as potential predictive metrics showed statistical correlation with increased interobserver variation, including target excursion and local target/lung contrast. Conclusion: Variability in pretreatment image guidance represents an important treatment consideration, particularly for stereotactic body radiation therapy, which employs small margins and a small number of treatment fractions. As a result of the data presented here, we have initiated weekly “registration rounds” to familiarize all staff physicians with the target and normal anatomy for each stereotactic body radiation therapy patient and minimize interobserver variations in image registration prior to treatment. The metrics shown here are capable of identifying patients for which large interobserver variations would be anticipated. These metrics may be used in the future to develop thresholds for additional interventions to mitigate registration variations.

A novel concept to include uncertainties in the evaluation of stereotactic body radiation therapy after 4D dose accumulation using deformable image registration

2019 ◽  
Vol 46 (10) ◽  
pp. 4346-4355
Author(s):  
Juan Diego Azcona ◽  
Carlos Huesa‐Berral ◽  
Marta Moreno‐Jiménez ◽  
Benigno Barbés ◽  
José Javier Aristu ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Image Registration ◽  
Stereotactic Body Radiation Therapy ◽  
Deformable Image Registration ◽  
Stereotactic Body Radiation ◽  
Dose Accumulation ◽  
Novel Concept

Stereotactic body radiation therapy to generate comparable survival to surgery in treating hepatocellular carcinoma (HCC): Results of 756 patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4080-4080
Author(s):  
Feng Ming Kong ◽  
Yong Zang ◽  
Wenhu Pi ◽  
David Long ◽  
Susannah Ellsworth ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
External Beam Radiation ◽  
Survival Outcomes ◽  
Front Line ◽  
Stereotactic Body Radiation ◽  
Significant Difference ◽  
Better Than

4080 Background: Stereotactic Body Radiation Therapy (SBRT) has emerged as a viable treatment option in patients with hepatocellular carcinoma (HCC). This study aimed to compare survival outcomes after SBRT with other front line local treatments for HCC. Methods: This is a retrospective analysis of patients identified through our cancer registry from 2000 to 2016. Patients treated with any local therapy alone were eligible: SBRT, surgery, conventional external beam radiation (CEBRT), and other local therapies including brachytherapy. Patients treated with combined therapies such as SBRT plus liver transplant were excluded. The primary endpoint was overall survival which was estimated from the time of diagnosis. Differences between the groups were compared using log-rank test. The data are presented as median (95%CI). Results: A total of 756 patients with a median follow-up of 45 months (mo) met the selection criteria: 116, 380, 43, and 217 patients received SBRT, surgery, CEBRT, and other local treatment, respectively. Median age was 61, 60, 61 and 60 years, respectively. The median overall survival/3 year overall survival rate were 49 (32-66) mo /53% (44-65%) for patients treated with SBRT, which were not significantly different from 75 (57-94) mo /63% (58-69%) of surgery (p = 0.27), non-significantly better than 22 (13-31) mo /41% (27-60%) of CEBRT (p = 0.13), significantly better than 15 (13-20) mo /26% (20-34%) of other local treatments (p = 3×10-7). After adjusting for significant prognostic factors including age, race, status of tobacco abuse, history of alcohol use, tumor size, histology grade and stage, the survival outcomes of SBRT remained to be insignificantly different from surgery (HR = 0.8, p = 0.2), have a trend of significant difference from CEBRT (HR = 1.4, p = 0.1) and remarkably superior to that of other local treatments (HR = 1.8, p = 2×10-4). Conclusions: This study suggests that SBRT is an excellent front line option for HCC, potentially comparable to surgical resection and associated with longer survival than other front line local treatments. Randomized studies are needed to validate these findings.

scholarly journals Comparison of single- and five-fraction schedules of stereotactic body radiation therapy for central lung tumours: a single institution experience

2017 ◽  
Vol 16 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Sung Jun Ma ◽  
Yusef A. Syed ◽  
Charlotte I. Rivers ◽  
Jorge A. Gomez Suescun ◽  
Anurag K. Singh
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Early Stage ◽  
Survival Rates ◽  
Study Data ◽  
Single Institution ◽  
Lung Tumours ◽  
Stereotactic Body Radiation ◽  
Significant Difference

AbstractBackgroundStereotactic body radiation therapy (SBRT) is a treatment option for patients with early-stage non-small cell lung cancer who are medically inoperable or decline surgery. Here we compare the outcome of patients with centrally located lung tumours who underwent either single fraction (SF)- or five-fraction (FF-) SBRT at a single institution over 5 years.MethodsBetween January 2009 and October 2014, patients with centrally located lung tumours who underwent SBRT were included in this study. Data were retrospectively collected using an institutional review board-approved database. For analysis, the Kaplan–Meier method and competing risks method were used.ResultsIn total, 11 patients received 26–30 Gy in 1 fraction, whereas 31 patients received 50–60 Gy (median 55 Gy) in 5 fractions. After a median follow-up of 12 months for SF-SBRT and 17 months for FF-SBRT groups (p=0·64), 1-year overall survival rates were 82 and 87%, respectively. SF- and FF-SBRT groups showed no significant difference in grade 3+ toxicity (p=0·28). The only grade 4 toxicity (n=1) was reported in the SF-SBRT group. All toxicities occurred >12 months after the SBRT.ConclusionsSF- and FF-SBRT have comparable overall survival. SF-SBRT may have some utility for patients unable to have multi-fraction SBRT.

scholarly journals A comparison of two modalities of stereotactic body radiation therapy for peripheral early-stage non-small cell lung cancer: results of a prospective French study

2020 ◽  
Vol 93 (1116) ◽  
pp. 20200256
Author(s):  
Line Claude ◽  
Magali Morelle ◽  
Marc-André Mahé ◽  
David Pasquier ◽  
Pierre Boisselier ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Stereotactic Body Radiation Therapy ◽  
Early Stage ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stereotactic Body Radiation ◽  
Significant Difference

Objectives: This prospective, observational, non-randomized multicentric study was conducted to compare efficiency and toxicity using different modalities of stereotactic body radiation therapy (SBRT) in early-stage peripheral non-small cell lung cancer (NSCLC). Methods: From 9 April to 11 December, 106 patients were treated according to the local equipment availability for peripheral NSCLC with SBRT: 68 by linear accelerator equipped for SBRT and 38 by Cyberknife®. Multivariate analysis and propensity score analysis using Inverse Probability Treatment Weighting (IPTW) were undertaken in an effort to adjust for potential bias due to non-randomization. Results: 2-year local control rates were 97.0% (95% CI: [90.6%; 99.4%]) with SBRT by Linac vs 100% (95% CI: ([100%; 100%]) with Cyberknife® (p = 0.2839). 2-year PFS and 2-year OS rates were 52.7% (95% CI [39.9%;64.0%]) versus 54.1% (95% CI [36.8; 68.6%]) (p = 0.8582) and 65.1% (95% CI: [51.9%; 75.5%] versus 83.9% (95% CI: [67.5%; 92.4%] (p = 0.0831) using Linac and Cyberknife® respectively. Multivariate regression analysis indicates no significant effect of SBRT treatment type on PFS or OS. Local relapse could not be modeled due to the small number of events (n = 2). Acute and late toxicity rates were not significantly different. After IPTW adjustment, results were unchanged. Conclusions: No difference in efficiency or toxicity was shown after SBRT of peripheral NSCLC treatment using Linac or Cyberknife®. Advances in knowledge: This is the first large prospective non-randomized study focusing on peripheral localized NSCLC comparing SBRT using an appropriately equipped linac with Cyberknife®. No significant difference in efficiency or toxicity was shown in this situation.

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