A Multi-atlas Approach for Active Bone Marrow Sparing Radiation Therapy: Implementation in the NRG-GY006 Trial

Autor: Casey W. Williamson, Tarrick Zaid, Tahir Yusufaly, Kevin L. Moore, Charles A. Leath, Loren K. Mell, Austin Miller, Tony Y. Eng, Ana Medina-Palomo, Katherine M. Moxley, Hannah Nguyen, Ying Xiao, Jessica Lowenstein, Carlos M. Chevere-Mourino
Rok vydání: 2020
Předmět:
Adult
Organs at Risk
Cancer Research
medicine.medical_treatment
Urinary Bladder
Uterine Cervical Neoplasms
Standardized uptake value
Article
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Bone Marrow
Fluorodeoxyglucose F18
Positron Emission Tomography Computed Tomography
Medical Illustration
medicine
Humans
Dosimetry
Radiology
Nuclear Medicine and imaging
Prospective Studies
Pelvic Bones
Aged
Aged
80 and over
Radiation
medicine.diagnostic_test
business.industry
Radiotherapy Planning
Computer-Assisted
Rectum
Femur Head
Chemoradiotherapy
Middle Aged
Confidence interval
Intestines
Radiation therapy
Clinical trial
medicine.anatomical_structure
Oncology
Positron emission tomography
030220 oncology & carcinogenesis
Linear Models
Feasibility Studies
Female
Bone marrow
Radiopharmaceuticals
Nuclear medicine
business
Organ Sparing Treatments
Zdroj: Int J Radiat Oncol Biol Phys
ISSN: 0360-3016
DOI: 10.1016/j.ijrobp.2020.06.071
Popis: PURPOSE: Sparing active bone marrow (ABM) can reduce acute hematologic toxicity in patients undergoing chemoradiotherapy for cervical cancer, but ABM segmentation based on positron emission tomography/computed tomography (PET/CT) is costly. We sought to develop an atlas-based ABM segmentation method for implementation in a prospective clinical trial. METHODS AND MATERIALS: A multiatlas was built on a training set of 144 patients and validated in 32 patients from the NRG-GY006 clinical trial. ABM for individual patients was defined as the subvolume of pelvic bone greater than the individual mean standardized uptake value on registered (18)F-fluorodeoxyglucose PET/CT images. Atlas-based and custom ABM segmentations were compared using the Dice similarity coefficient and mean distance to agreement and used to generate ABM-sparing intensity modulated radiation therapy plans. Dose-volume metrics and normal tissue complication probabilities of the two approaches were compared using linear regression. RESULTS: Atlas-based ABM volumes (mean [standard deviation], 548.4 [88.3] cm(3)) were slightly larger than custom ABM volumes (535.1 [93.2] cm(3)), with a Dice similarity coefficient of 0.73. Total pelvic bone marrow V(20) and D(mean) were systematically higher and custom ABM V(10) was systematically lower with custom-based plans (slope: 1.021 [95% confidence interval (CI), 1.005-1.037], 1.014 [95% CI, 1.006-1.022], and 0.98 [95% CI, 0.97-0.99], respectively). We found no significant differences between atlas-based and custom-based plans in bowel, rectum, bladder, femoral heads, or target dose-volume metrics. CONCLUSIONS: Atlas-based ABM segmentation can reduce pelvic bone marrow dose while achieving comparable target and other normal tissue dosimetry. This approach may allow ABM sparing in settings where PET/CT is unavailable.
Databáze: OpenAIRE
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