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Evaluating the need for adaptive therapy when delivering conformal bladder radiotherapy

Published online by Cambridge University Press:  12 January 2016

Ann M. Henry ,
Helen Summers ,
Louise Murray ,
Ankit Jain ,
Wasif Tahir ,
Saadat Ali ,
Joji Joseph ,
Sarah Bastow ,
Rebecca Artschan  and
Jonathan Sykes
Ann M. Henry*
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK University of Leeds, UK
Helen Summers
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Louise Murray
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Ankit Jain
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Wasif Tahir
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Saadat Ali
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Joji Joseph
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Sarah Bastow
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Rebecca Artschan
Affiliation:
Department of Medical Physics, St James’s University Hospital, UK
Jonathan Sykes
Affiliation:
Department of Medical Physics, St James’s University Hospital, UK
*
Correspondence to: Dr Ann M Henry, St. James’s University Hospital, Beckett St, Leeds, West Yorkshire LS9 7TF, UK. Tel: 44 113 206 7630. Fax: 44 113 206 7582. E-mail: [email protected]
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Abstract

Background and purpose

The purpose of this study was to audit positioning errors during bladder image-guided radiotherapy (IGRT) and quantify survival outcomes.

Materials and methods

We carried out a retrospective review of 141 patients treated between March 2007 and July 2010 with three-dimensional conformal radiotherapy. An offline imaging protocol using kV cone beam computed tomography (CBCT) was used. Positioning errors, clinical interventions and re-planning rates were quantified. Cancer outcomes and survival were collected by review of patient notes and a registry search.

Results

Among all, 43% of the patients required no intervention. Isocentre corrections were used for systematic bony set-up error in 13% and to improve bladder coverage in 28%. Clinical interventions to improve bladder coverage were required in 16% of the patients and repeat computed tomography planning in a further 16%. Overall, 44% of the patients demonstrated some form of organ deformation that would have resulted in inadequate dose to the bladder or significant overdose to an organ at risk if not corrected for. Post-treatment check cystoscopy was undertaken in 107 patients (76%) with 72 noted to have a complete response. Overall survival was 47·8% at 3 years.

Conclusions

Organ deformation during radiotherapy for bladder cancer is a significant problem for over 40% of patients. Strategies to compensate are essential to ensure optimal plan delivery.

Keywords

adaptive radiotherapybladder cancerexternal beam radiotherapyimage-guided radiotherapyorgan motion
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 1 , March 2016 , pp. 15 - 22
Copyright
© Cambridge University Press 2016 

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References

1.Cancer Research UK. Bladder cancer statistics, 2015. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bladder-cancer#heading-Zero. Accessed on 15th June 2015.Google Scholar
2.Chahal, R, Sundaram, SK, Iddenden, R, Forman, DF, Weston, PM, Harrison, SC. A study of the morbidity, mortality and long-term survival following radical cystectomy and radical radiotherapy in the treatment of invasive bladder cancer in Yorkshire. Eur Urol 2003; 43: 246–257.CrossRefGoogle ScholarPubMed
3.NICE. Bladder cancer: diagnosis and management, 2015. http://www.nice.org.uk/guidance/ng2/evidence/full-guideline-3744109. Accessed on 15th June 2015.Google Scholar
4.Tester, W, Caplan, R, Heaney, Jet al. Neoadjuvant combined modality program with selective organ preservation for invasive bladder cancer: results of Radiation Therapy Oncology Group phase II trial 8802. J Clin Oncol 1996; 14: 119–126.CrossRefGoogle ScholarPubMed
5.Kaufman, DS, Shipley, WU, Feldman, AS. Bladder cancer. Lancet 2009; 374: 239–249.CrossRefGoogle ScholarPubMed
6.Sur, RK, Clinkard, J, Jones, WGet al. Changes in target volume during radiotherapy treatment of invasive bladder carcinoma. Clin Oncol (R Coll Radiol) 1993; 5: 30–33.CrossRefGoogle ScholarPubMed
7.Lalondrelle, S, Huddart, R. Improving radiotherapy for bladder cancer: an opportunity to integrate new technologies. Clin Oncol (R Coll Radiol) 2009; 21: 380–384.CrossRefGoogle ScholarPubMed
8.Lalondrelle, S, Huddart, R, Warren-Oseni, Ket al. Adaptive-predictive organ localization using cone-beam computed tomography for improved accuracy in external beam radiotherapy for bladder cancer. Int J Radiat Oncol Biol Phys 2011; 79: 705–712.CrossRefGoogle ScholarPubMed
9.Burridge, N, Amer, A, Marchant, Tet al. Online adaptive radiotherapy of the bladder: small bowel irradiated-volume reduction. Int J Radiat Oncol Biol Phys 2006; 66: 892–897.CrossRefGoogle ScholarPubMed
10.Button, MR, Staffurth, JN. Clinical application of image-guided radiotherapy in bladder and prostate cancer. Clin Oncol (R Coll Radiol) 2010; 22: 698–706.CrossRefGoogle ScholarPubMed
11.NHS England. Image guided radiotherapy (IGRT): guidance for implementation and use, NRIG Report, NHS England, 2012.Google Scholar
12.Greener, AG. Practical determination of systematic and random set-up errors using portal imaging. In: McKenzie A ed. Geometric Uncertainties in Radiotherapy Treatment Planning. London: The British Institute of Radiology, 2003: 44–46.Google Scholar
13.Hurkmans, CW, Remeijer, P, Lebesque, JV, Mijnheer, BJ. Set-up verification using portal imaging; review of current clinical practice. Radiother Oncol 2001; 58: 105–120.CrossRefGoogle ScholarPubMed
14.On target:ensuring geometric accuracy in radiotherapy. RCR/IPEM/SOR joint publication, 2008. London. ISBN:978-1-905034-33-8.Google Scholar
15.Foroudi, F, Wong, J, Kron, Tet al. Online adaptive radiotherapy for muscle-invasive bladder cancer: results of a pilot study. Int J Radiat Oncol Biol Phys 2011; 81: 765–771.CrossRefGoogle ScholarPubMed
16.Murthy, V, Master, Z, Adurkar, Pet al. ‘Plan of the day’ adaptive radiotherapy for bladder cancer using helical tomotherapy. Radiother Oncol 2011; 99: 55–60.CrossRefGoogle ScholarPubMed
17.McDonald, F, Lalondrelle, S, Taylor, Het al. Clinical implementation of adaptive hypofractionated bladder radiotherapy for improvement in normal tissue irradiation. Clin Oncol (R Coll Radiol) 2013; 25: 549–556.CrossRefGoogle ScholarPubMed
18.The Institute of Cancer Research. RAIDER: a randomised phase II trial of adaptive image guided standard or dose escalated tumour boost radiotherapy in the treatment of transitional cell carcinoma of the bladder, 2015. http://www.icr.ac.uk/our-research/our-research-centres/clinical-trials-and-statistics-unit/clinical-trials/raider. Accessed on 15th June 2015.Google Scholar
19.Fokdal, L, Honore, H, Hoyer, M, Meldgaard, P, Fode, K, von der Maase, H. Impact of changes in bladder and rectal filling volume on organ motion and dose distribution of the bladder in radiotherapy for urinary bladder cancer. Int J Radiat Oncol Biol Phys 2004; 59: 436–444.CrossRefGoogle ScholarPubMed
20.Hutton, D, Blair, D, Baker, A, Callender, J. Evaluating the role of a micro-enema to reduce rectal volume variation and gas during radiotherapy for bladder cancer. Radiother Oncol 2015; 115 (suppl 1): S200–S201.CrossRefGoogle Scholar
21.James, ND, Hussain, SA, Hall, Eet al. Radiotherapy with or without chemotherapy in muscle invasive bladder cancer. N Engl J Med 2012; 366: 1477–1488.CrossRefGoogle ScholarPubMed