Prediction of Pathologic Response to Neoadjuvant Chemoradiotherapy in Patients with Esophageal Squamous Cell Carcinoma Incorporating Hematological Biomarkers / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to develop a nomogram for predicting pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma (ESCC) by integrating hematological biomarkers and clinicopathological characteristics. @*Materials and Methods@#Between 2003 and 2017, 306 ESCC patients who underwent neoadjuvant CRT followed by esophagectomy were analyzed. Besides clinicopathological factors, hematological parameters before, during, and after CRT were collected. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for pCR. A nomogram model was built and internally validated. @*Results@#Absolute lymphocyte count (ALC), lymphocyte to monocyte ratio, albumin, hemoglobin, white blood cell, neutrophil, and platelet count generally declined, whereas neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) increased significantly following neoadjuvant CRT. After surgery, 124 patients (40.5%) achieved a pCR. The pCR group demonstrated significantly more favorable survival than the non-pCR group. On multivariate analysis, significant factors associated with pCR included sex, chemotherapy regimen, post-CRT endoscopic finding, pre-CRT NLR, ALC nadir during CRT, and post-CRT PLR, which were incorporated into the prediction model. The nomogram indicated good accuracy in predicting pCR, with a C-index of 0.75 (95% confidence interval, 0.71 to 0.78). @*Conclusion@#Female, chemotherapy regimen of cisplatin/vinorelbine, negative post-CRT endoscopic finding, pre-CRT NLR (≤ 2.1), ALC nadir during CRT (> 0.35 ×109/L), and post-CRT PLR (≤ 83.0) were significantly associated with pCR in ESCC patients treated with neoadjuvant CRT. A nomogram incorporating hematological biomarkers to predict pCR was developed and internally validated, showing good predictive performance.

Accuracy of different image registration methods in image-guided adaptive brachytherapy for cervical cancer / 南方医科大学学报

OBJECTIVE@#To compare the accuracy of different methods for image registration in image-guided adaptive brachytherapy (IGABT) for cervical cancer.@*METHODS@#The last treatment planning CT images (CT1) and the first treatment planning CT images (CT2) were acquired from 15 patients with cervical cancer and registered with different match image qualities (retained/removed catheter source in images) and different match regions [target only (S Group)/ interested organ structure (M Group)/body (L Group)] in Velocity3.2 software. The dice similarity coefficient (DSC) between the clinical target volumes (CTV) of the CT1 and CT2 images (CTVCT1 and CTVCT2, respectively) and between the organs-at-risk (OAR) of the two imaging datasets (OARCT1 and OARCT2, respectively) were used to evaluate the image registration accuracy.@*RESULTS@#The auto-segmentation volume of the catheter source using Velocity software based on the CT threshold was the closest to the actual volume within the CT value range of 1700-1800 HU. In the retained group, the DSC for the OARs of was better than or equal to that of the removed group, and the DSC value of the rectum was significantly improved ( < 0.05). For comparison of different match regions, the high-risk target volume (HRCTV) and the low-risk target volume (IRCTV) had the best precision for registration of the target area, which was significantly greater than that of M group and L group ( < 0.05). The M group had better registration accuracy of the target area and the best accuracy for the OARs. The DSC values of the bladder and rectum were significantly better than those of the other two groups ( < 0.05).@*CONCLUSIONS@#The CT value range of 1700-1800 HU is optimal for automatic image segmentation using Velocity software. Automatic segmentation and shielding the volume of the catheter source can improve the image quality. We recommend the use of interested organ structures regions for image registration in image-guided adaptive brachytherapy for cervical cancer.

A quantitative evaluation of quality control image for on-board imaging system of medical linear accelerator / 中华放射肿瘤学杂志

Objective To establish a quantitative evaluation of quality control image for the onboard imaging system of medical linear accelerator.Methods An MV planar image of electronic portal imaging device (EPID) is acquired by both Elekta iViewGT and Varian aS1000,and a kV planar image and cone-beam computed tomography (CBCT) images of CBCT are acquired by both Elekta X-ray volume imaging (XVI) and Varian On-board Imager (OBI).Phantoms used here included Las Vegas,TOR18FG,and Catphan504.A series of image quality indicators were evaluated by analyzing the images mentioned above using a quantitative method.Results A quantitative value was calculated to represent the contrast resolution of EPID.A modulation transfer function (MTF) to describe spatial resolution and a quantitative value representing contrast resolution were calculated for the kV planar image.As for the CBCT system,a series of quantitative results of noise,uniformity,CT value accuracy,and contrast resolution and a MTF were calculated to represent the performance of CBCT system.Conclusions Based on common phantoms,a complete set of quantitative methods to evaluate the image quality of EPID and CBCT has been developed,which could provide a very good reference for the establishment of quality control system for image-guided radiotherapy.

Independent 3D dose calculation for IMRT based on simplification of beam model and collapsed-cone convolution/superposition algorithm / 中华放射肿瘤学杂志

Objective To realize independent 3D dose calculation for intensity-modulated radiotherapy (IMRT) by building a two-source beam model of medical linear accelerator combined with a collapsed-cone convolution/superposition (CCCS) algorithm.Methods Two-source beam models of medical linear accelerators (Varian and Elekta) were built to calculate the 3D dose distributions using the CCCS algorithm.Scp,percent depth dose,and off-axis dose distribution were compared with the scanning data of ion chamber to confirm the calculation model.Twelve intensity-modulated treatment plans from each accelerator (a total of 24 plans) were selected for comparison.The calculation results of treatment planning system (TPS) were independently validated,and further compared with the measurement results of detector matrix.Results The dose deviations at the center of rectangle fields were lower than 1%,the deviation between doses at the same position in the field was not higher than 1%,and the positional deviation in the penumbra region was not higher than 1 mm.Gamma analysis based on 3%/3 mm standard was used to compare the results calculated by detectors and TPS.The pass rates were higher than 90%.Conclusions The independent 3D dose calculation for IMRT based on two-source beam model combined with CCCS algorithm has been successfully set up.The comparison between regular field and IMRT plan indicates that this method and calculation model can be used for independent 3D dose calculation of clinical plan.

Development and evaluation of a predicting model of dose volume histograms of parotid in NPC IMRT planning / 中华放射肿瘤学杂志

Objective To study the mathematical predicting model of parotid DVH for the NPC IMRT planning, and its accuracy with the analysis of medical data. Methods 50 NPC radiotherapy treatment plans with same beam setup were chosen as sample data set, then their parotid DVHs and distance of voxels in the parotid to the target volumes were calculated with self-developed program to form the distance to target histogram ( DTHs);principal component analysis was applied to DVHs and DTHs to acquire their principal components ( PCs) ,and then nonlinear multiple variable regression was used to model correlation between the DTHs' PCs, parotids volume, PTVs and the DVHs. Another 10 plans were chosen as test data set to evaluate the efficacy and accuracy of the final model by comparing the DVHs calculated from our model with those calculated from the TPS. Results Up to 97% information of DTHs and DVHs can be represented with 2 to 3 components, the average fitting error of sample data set was (0±3. 5)%;in the 10 test cases, the shapes of DVH curves calculated from predicting model was highly the same with those from the TPS, the average modeling error was (-0.7± 4. 4)%,the accuracy of prediction was up 95%. Conclusions Our developed model can be used as a quality evaluating tool to predict and assure the dose distribution in parotid of NPC radiotherapy treatment planning effectively and accurately.

Measurement of leaf position accuracy of dynamic multi-leaf collimator using electronic portal imaging device and EBT3 film dosimeter / 中华放射肿瘤学杂志

Objective To establish a fast and accurate method for measurement of leaf position accuracy of dynamic multi-leaf collimator (MLC) using electronic portal imaging device (EPID) and EBT3 film dosimeter.Methods A Varian 6 MV accelerator was used with the gantry angle and the collimator angle fixed at zero degree.A total of 11 sliding window MLC fields were designed.Each field contained a group of strip fields with the same width.The width of a strip field ranged from 1 mm to 10 mm and the distance between two adjacent strip fields was 20 mm.The relationship between the width of the strip field (band width) and the full width at half maximum (FWHM) was calibrated using EPID and EBT3 as measurement tools.A field with a band width of 5 mm was designed in the same way and several MLC leaf deviations were made in different positions.EPID and EBT3 film dosimeter were used to analyze the leaf position accuracy.Results A good linear relationship between band width and FWHM was achieved when the band width was larger than 4 mm.The accuracy of band width,distance between peaks,and MLC leaf position were determined as ±0.2 mm,±0.1 mm,and ±0.1 mm by EPID and ±0.3 mm,±0.2 mm,and ± 0.2 mm by EBT3 film dosimeter,respectively.Conclusions This study provides a fast and accurate method for the measurement of MLC leaf position accuracy using EPID or EBT3 film dosimeter,which is helpful for quality assurance of MLC.

The study of two-dimensional dosimetric verifications of volumetric intensity-modulated arc therapy based on electronic portal imaging devices / 中华放射肿瘤学杂志

Objective To develop an accurate 2D dose reconstruction model using electronic portal imaging device (EPID).2D dosimetric verifications of volumetric intensity-modulated arc therapy (VIMAT)were done using the model.And the results were compared to other dosimeters.Methods The EPID-based dose reconstruction model was using convolve,deconvolve and correction function.The dose profiles which were obtained by the ion chamber were used to determine the model parameters.A total of 12 VIMAT plans for the treatment of anatomical sites of various complexities were chosen.The results obtained from EPID were compared to other dosimeters and treatment planning system (TPS).The ion chamber was used to measure the central point absolute doses.Other dosimeters were used to measure the plane dose distributions.All dosimeters measured the dose at 10 cm depth.The results were analyzed using γevaluation method.Results Regarding absolute central point doses,the ion chamber results were within 1.5％ of the EPID results.For the comparison to Seven29 and Matrixx,the average γ pass rates with 2％and 2 mm criteria were 98.9％ and 99.8％ respectively.For the dose distributions measured by EPID and calculated by TPS,the γ pass rates with 3％ and 3 mm criteria were 99.9％.Conclusions The presented results which were obtained from the comparison of measured and calculated doses show the reliability of our EPID-based dose reconstruction model.With the model,EPID can be a reliable and fast tool for IMRT plan dosimetric verification.The model expanded to the 3D dosimetric verification in the uniform phantom will be considered as the next work.