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Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases
To perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases. Diagnostic computed tomographies (CT) of patients c...
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| Published in: | Frontiers in oncology 2021-12, Vol.11, p.767468-767468 |
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| container_title | Frontiers in oncology |
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| creator | Scafa, Davide Muedder, Thomas Holz, Jasmin A Koch, David Nour, Younéss Garbe, Stephan Gonzalez-Carmona, Maria A Feldmann, Georg Vilz, Tim O Köksal, Mümtaz Giordano, Frank A Schmeel, Leonard Christopher Sarria, Gustavo R |
| description | To perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases.
Diagnostic computed tomographies (CT) of patients carrying one or two lesions |
| doi_str_mv | 10.3389/fonc.2021.767468 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_54b6e3c1a79d4658a6e712651bdd8860</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_54b6e3c1a79d4658a6e712651bdd8860</doaj_id><sourcerecordid>2612021730</sourcerecordid><originalsourceid>FETCH-LOGICAL-c415t-96dadd33dacceb2cb756863f2d0708f0f8a26eadc3df4c899315ece30203d1db3</originalsourceid><addsrcrecordid>eNpVkU1v1DAQhi0EolXpnRPykcsu_khs54KEFigrLUL9QOJmTexx6yqJg52t1H_fhC1Va43kGc_MM7ZfQt5ztpbSNJ9CGtxaMMHXWulKmVfkWAhZrZpK_nn9zD8ip6XcsnmpmnEm35IjWTVCCc2PyfnXVGKPU46OblI_Qo4lDTQFuh2mDGnEDFO8Q3oBPqbpZg7HewqDp5cXlzSkTHdzNtOfOEGZDcs78iZAV_D0cT8hv79_u9r8WO1-nW03X3YrV_F6WjXKg_dSenAOW-FaXSujZBCeaWYCCwaEQvBO-lA50zSS1-hQMsGk576VJ2R74PoEt3bMsYd8bxNE--8g5WsLeYquQ1tXrULpOOjGV6o2oFBzoWreem-MYjPr84E17tsevcPl7d0L6MvMEG_sdbqzZv55rpsZ8PERkNPfPZbJ9rE47DoYMO2LFYovSmm5zGKHUpdTKRnD0xjO7CKsXYS1S7k9CDu3fHh-vaeG_zLKB9wRoRM</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2612021730</pqid></control><display><type>article</type><title>Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases</title><source>PubMed Central Free</source><creator>Scafa, Davide ; Muedder, Thomas ; Holz, Jasmin A ; Koch, David ; Nour, Younéss ; Garbe, Stephan ; Gonzalez-Carmona, Maria A ; Feldmann, Georg ; Vilz, Tim O ; Köksal, Mümtaz ; Giordano, Frank A ; Schmeel, Leonard Christopher ; Sarria, Gustavo R</creator><creatorcontrib>Scafa, Davide ; Muedder, Thomas ; Holz, Jasmin A ; Koch, David ; Nour, Younéss ; Garbe, Stephan ; Gonzalez-Carmona, Maria A ; Feldmann, Georg ; Vilz, Tim O ; Köksal, Mümtaz ; Giordano, Frank A ; Schmeel, Leonard Christopher ; Sarria, Gustavo R</creatorcontrib><description>To perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases.
Diagnostic computed tomographies (CT) of patients carrying one or two lesions <4 cm and who underwent surgery were retrospectively screened and randomly selected for the study. For DIBH-SRS, a gross target volume (GTV) plus planning target volume (PTV) were delineated. For FB-SRS, a GTV plus an internal target volume (ITV) and PTV were defined. Accounting for the maximal GTV diameters, a modified GTV (GTV-IORT) was expanded circumferentially to simulate a resection cavity. The best suitable round-applicator size was thereafter selected. All treatment plans were calculated homogeneously to deliver 40 Gy. Doses delivered to organs at risk (OAR) and target volumes were compared for IORT vs. both SRS modalities.
Eight patients encompassing 10 lesions were included in the study. The mean liver volume was 2,050.97 cm
(SD, 650.82), and the mean GTV volume was 12.23 cm
(SD, 12.62). As for target structures, GTV-IORT [19.44 cm
(SD, 17.26)] were significantly smaller than both PTV DIBH-SRS [30.74 cm
(SD, 24.64), p = 0.002] and PTV FB-SRS [75.82 cm
(SD, 45.65), p = 0.002]. The median applicator size was 3 cm (1.5-4.5), and the mean IORT simulated delivery time was 45.45 min (SD, 19.88). All constraints were met in all modalities. Liver V
showed significantly smaller volumes with IORT [63.39 cm
(SD, 35.67)] when compared to DIBH-SRS [150.12 cm
(SD, 81.43), p = 0.002] or FB-SRS [306.13 cm
(SD, 128.75), p = 0.002]. No other statistical or dosimetrically relevant difference was observed for stomach, spinal cord, or biliary tract. Mean IORT D
was 85.3% (SD, 6.05), whereas D
for DIBH-SRS and FB-SRS were 99.03% (SD, 1.71; p = 0.042) and 98.04% (SD, 3.46; p = 0.036), respectively.
Kilovoltage IORT bears the potential as novel add-on treatment for resectable liver metastases, significantly reducing healthy liver exposure to radiation in comparison to SRS. Prospective clinical evidence is required to confirm this hypothesis.</description><identifier>ISSN: 2234-943X</identifier><identifier>EISSN: 2234-943X</identifier><identifier>DOI: 10.3389/fonc.2021.767468</identifier><identifier>PMID: 34926271</identifier><language>eng</language><publisher>Switzerland: Frontiers Media S.A</publisher><subject>intraoperative ; IORT ; kilovoltage ; liver metastases ; Oncology ; SRS</subject><ispartof>Frontiers in oncology, 2021-12, Vol.11, p.767468-767468</ispartof><rights>Copyright © 2021 Scafa, Muedder, Holz, Koch, Nour, Garbe, Gonzalez-Carmona, Feldmann, Vilz, Köksal, Giordano, Schmeel and Sarria.</rights><rights>Copyright © 2021 Scafa, Muedder, Holz, Koch, Nour, Garbe, Gonzalez-Carmona, Feldmann, Vilz, Köksal, Giordano, Schmeel and Sarria 2021 Scafa, Muedder, Holz, Koch, Nour, Garbe, Gonzalez-Carmona, Feldmann, Vilz, Köksal, Giordano, Schmeel and Sarria</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c415t-96dadd33dacceb2cb756863f2d0708f0f8a26eadc3df4c899315ece30203d1db3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674179/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674179/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34926271$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scafa, Davide</creatorcontrib><creatorcontrib>Muedder, Thomas</creatorcontrib><creatorcontrib>Holz, Jasmin A</creatorcontrib><creatorcontrib>Koch, David</creatorcontrib><creatorcontrib>Nour, Younéss</creatorcontrib><creatorcontrib>Garbe, Stephan</creatorcontrib><creatorcontrib>Gonzalez-Carmona, Maria A</creatorcontrib><creatorcontrib>Feldmann, Georg</creatorcontrib><creatorcontrib>Vilz, Tim O</creatorcontrib><creatorcontrib>Köksal, Mümtaz</creatorcontrib><creatorcontrib>Giordano, Frank A</creatorcontrib><creatorcontrib>Schmeel, Leonard Christopher</creatorcontrib><creatorcontrib>Sarria, Gustavo R</creatorcontrib><title>Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases</title><title>Frontiers in oncology</title><addtitle>Front Oncol</addtitle><description>To perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases.
Diagnostic computed tomographies (CT) of patients carrying one or two lesions <4 cm and who underwent surgery were retrospectively screened and randomly selected for the study. For DIBH-SRS, a gross target volume (GTV) plus planning target volume (PTV) were delineated. For FB-SRS, a GTV plus an internal target volume (ITV) and PTV were defined. Accounting for the maximal GTV diameters, a modified GTV (GTV-IORT) was expanded circumferentially to simulate a resection cavity. The best suitable round-applicator size was thereafter selected. All treatment plans were calculated homogeneously to deliver 40 Gy. Doses delivered to organs at risk (OAR) and target volumes were compared for IORT vs. both SRS modalities.
Eight patients encompassing 10 lesions were included in the study. The mean liver volume was 2,050.97 cm
(SD, 650.82), and the mean GTV volume was 12.23 cm
(SD, 12.62). As for target structures, GTV-IORT [19.44 cm
(SD, 17.26)] were significantly smaller than both PTV DIBH-SRS [30.74 cm
(SD, 24.64), p = 0.002] and PTV FB-SRS [75.82 cm
(SD, 45.65), p = 0.002]. The median applicator size was 3 cm (1.5-4.5), and the mean IORT simulated delivery time was 45.45 min (SD, 19.88). All constraints were met in all modalities. Liver V
showed significantly smaller volumes with IORT [63.39 cm
(SD, 35.67)] when compared to DIBH-SRS [150.12 cm
(SD, 81.43), p = 0.002] or FB-SRS [306.13 cm
(SD, 128.75), p = 0.002]. No other statistical or dosimetrically relevant difference was observed for stomach, spinal cord, or biliary tract. Mean IORT D
was 85.3% (SD, 6.05), whereas D
for DIBH-SRS and FB-SRS were 99.03% (SD, 1.71; p = 0.042) and 98.04% (SD, 3.46; p = 0.036), respectively.
Kilovoltage IORT bears the potential as novel add-on treatment for resectable liver metastases, significantly reducing healthy liver exposure to radiation in comparison to SRS. Prospective clinical evidence is required to confirm this hypothesis.</description><subject>intraoperative</subject><subject>IORT</subject><subject>kilovoltage</subject><subject>liver metastases</subject><subject>Oncology</subject><subject>SRS</subject><issn>2234-943X</issn><issn>2234-943X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpVkU1v1DAQhi0EolXpnRPykcsu_khs54KEFigrLUL9QOJmTexx6yqJg52t1H_fhC1Va43kGc_MM7ZfQt5ztpbSNJ9CGtxaMMHXWulKmVfkWAhZrZpK_nn9zD8ip6XcsnmpmnEm35IjWTVCCc2PyfnXVGKPU46OblI_Qo4lDTQFuh2mDGnEDFO8Q3oBPqbpZg7HewqDp5cXlzSkTHdzNtOfOEGZDcs78iZAV_D0cT8hv79_u9r8WO1-nW03X3YrV_F6WjXKg_dSenAOW-FaXSujZBCeaWYCCwaEQvBO-lA50zSS1-hQMsGk576VJ2R74PoEt3bMsYd8bxNE--8g5WsLeYquQ1tXrULpOOjGV6o2oFBzoWreem-MYjPr84E17tsevcPl7d0L6MvMEG_sdbqzZv55rpsZ8PERkNPfPZbJ9rE47DoYMO2LFYovSmm5zGKHUpdTKRnD0xjO7CKsXYS1S7k9CDu3fHh-vaeG_zLKB9wRoRM</recordid><startdate>20211202</startdate><enddate>20211202</enddate><creator>Scafa, Davide</creator><creator>Muedder, Thomas</creator><creator>Holz, Jasmin A</creator><creator>Koch, David</creator><creator>Nour, Younéss</creator><creator>Garbe, Stephan</creator><creator>Gonzalez-Carmona, Maria A</creator><creator>Feldmann, Georg</creator><creator>Vilz, Tim O</creator><creator>Köksal, Mümtaz</creator><creator>Giordano, Frank A</creator><creator>Schmeel, Leonard Christopher</creator><creator>Sarria, Gustavo R</creator><general>Frontiers Media S.A</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20211202</creationdate><title>Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases</title><author>Scafa, Davide ; Muedder, Thomas ; Holz, Jasmin A ; Koch, David ; Nour, Younéss ; Garbe, Stephan ; Gonzalez-Carmona, Maria A ; Feldmann, Georg ; Vilz, Tim O ; Köksal, Mümtaz ; Giordano, Frank A ; Schmeel, Leonard Christopher ; Sarria, Gustavo R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-96dadd33dacceb2cb756863f2d0708f0f8a26eadc3df4c899315ece30203d1db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>intraoperative</topic><topic>IORT</topic><topic>kilovoltage</topic><topic>liver metastases</topic><topic>Oncology</topic><topic>SRS</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scafa, Davide</creatorcontrib><creatorcontrib>Muedder, Thomas</creatorcontrib><creatorcontrib>Holz, Jasmin A</creatorcontrib><creatorcontrib>Koch, David</creatorcontrib><creatorcontrib>Nour, Younéss</creatorcontrib><creatorcontrib>Garbe, Stephan</creatorcontrib><creatorcontrib>Gonzalez-Carmona, Maria A</creatorcontrib><creatorcontrib>Feldmann, Georg</creatorcontrib><creatorcontrib>Vilz, Tim O</creatorcontrib><creatorcontrib>Köksal, Mümtaz</creatorcontrib><creatorcontrib>Giordano, Frank A</creatorcontrib><creatorcontrib>Schmeel, Leonard Christopher</creatorcontrib><creatorcontrib>Sarria, Gustavo R</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Frontiers in oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scafa, Davide</au><au>Muedder, Thomas</au><au>Holz, Jasmin A</au><au>Koch, David</au><au>Nour, Younéss</au><au>Garbe, Stephan</au><au>Gonzalez-Carmona, Maria A</au><au>Feldmann, Georg</au><au>Vilz, Tim O</au><au>Köksal, Mümtaz</au><au>Giordano, Frank A</au><au>Schmeel, Leonard Christopher</au><au>Sarria, Gustavo R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases</atitle><jtitle>Frontiers in oncology</jtitle><addtitle>Front Oncol</addtitle><date>2021-12-02</date><risdate>2021</risdate><volume>11</volume><spage>767468</spage><epage>767468</epage><pages>767468-767468</pages><issn>2234-943X</issn><eissn>2234-943X</eissn><abstract>To perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases.
Diagnostic computed tomographies (CT) of patients carrying one or two lesions <4 cm and who underwent surgery were retrospectively screened and randomly selected for the study. For DIBH-SRS, a gross target volume (GTV) plus planning target volume (PTV) were delineated. For FB-SRS, a GTV plus an internal target volume (ITV) and PTV were defined. Accounting for the maximal GTV diameters, a modified GTV (GTV-IORT) was expanded circumferentially to simulate a resection cavity. The best suitable round-applicator size was thereafter selected. All treatment plans were calculated homogeneously to deliver 40 Gy. Doses delivered to organs at risk (OAR) and target volumes were compared for IORT vs. both SRS modalities.
Eight patients encompassing 10 lesions were included in the study. The mean liver volume was 2,050.97 cm
(SD, 650.82), and the mean GTV volume was 12.23 cm
(SD, 12.62). As for target structures, GTV-IORT [19.44 cm
(SD, 17.26)] were significantly smaller than both PTV DIBH-SRS [30.74 cm
(SD, 24.64), p = 0.002] and PTV FB-SRS [75.82 cm
(SD, 45.65), p = 0.002]. The median applicator size was 3 cm (1.5-4.5), and the mean IORT simulated delivery time was 45.45 min (SD, 19.88). All constraints were met in all modalities. Liver V
showed significantly smaller volumes with IORT [63.39 cm
(SD, 35.67)] when compared to DIBH-SRS [150.12 cm
(SD, 81.43), p = 0.002] or FB-SRS [306.13 cm
(SD, 128.75), p = 0.002]. No other statistical or dosimetrically relevant difference was observed for stomach, spinal cord, or biliary tract. Mean IORT D
was 85.3% (SD, 6.05), whereas D
for DIBH-SRS and FB-SRS were 99.03% (SD, 1.71; p = 0.042) and 98.04% (SD, 3.46; p = 0.036), respectively.
Kilovoltage IORT bears the potential as novel add-on treatment for resectable liver metastases, significantly reducing healthy liver exposure to radiation in comparison to SRS. Prospective clinical evidence is required to confirm this hypothesis.</abstract><cop>Switzerland</cop><pub>Frontiers Media S.A</pub><pmid>34926271</pmid><doi>10.3389/fonc.2021.767468</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | intraoperative IORT kilovoltage liver metastases Oncology SRS |
| title | Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases |
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