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Surface guided radiation therapy with an innovative open-face mask and mouth bite: patient motion management in brain stereotactic radiotherapy

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Abstract

Introduction

To guarantee treatment reproducibility and stability, immobilization devices are essential. Additionally, surface-guided radiation therapy (SGRT) serves as an accurate complement to frameless stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) by aiding patient positioning and real-time monitoring, especially when non-coplanar fields are in use. At our institute, we have developed a surface-guided SRS (SG-SRS) workflow that incorporates our innovative open-face mask (OM) and mouth bite (MB) to guarantee a precise and accurate dose delivery.

Methods

This study included 40 patients, and all patients were divided into closed mask (CM) and open-face mask (OM) groups according to different positioning flow. Cone beam computed tomography (CBCT) scans were performed, and the registration results were recorded before and after the treatment. Then Bland–Altman method was used to analyze the consistency of AlignRT-guided positioning errors and CBCT scanning results in the OM group. The error changes between 31 fractions in one patient were recorded to evaluate the feasibility of monitoring during treatment.

Results

The median of translation error between stages of the AlignRT positioning process was (0.03–0.07) cm, and the median of rotation error was (0.20–0.40)°, which were significantly better than those of the Fraxion positioning process (0.09–0.11) cm and (0.60–0.75)°. The mean bias values between the AlignRT guided positioning errors and CBCT were 0.01 cm, − 0.07 cm, 0.03 cm, − 0.30°, − 0.08° and 0.00°. The 31 inter-fractional errors of a single patient monitored by SGRT were within 0.10 cm and 0.50°.

Conclusions

The application of the SGRT with an innovative open-face mask and mouth bite device could achieve precision positioning accuracy and stability, and the accuracy of the AlignRT system exhibits excellent constancy with the CBCT gold standard. The non-coplanar radiation field monitoring can provide reliable support for motion management in fractional treatment.

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Data availability

The data that supports the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Chen JCT, Bugoci DM, Girvigian MR, Miller MJ, Arellano A, Rahimian J. Control of brain metastases using frameless image-guided radiosurgery. Neurosurg Focus. 2009;27(6):E6.

    Article  PubMed  Google Scholar 

  2. Alongi F, Fiorentino A, Mancosu P, Navarria P, Levra NG, Mazzola R, et al. Stereotactic radiosurgery for intracranial metastases: linac-based and gamma dedicated unit approach. Expert Rev Anticancer Ther. 2016;16(7):731–40.

    Article  CAS  PubMed  Google Scholar 

  3. Bilger A, Frenzel F, Oehlke O, Wiehle F, Milanovic D, Prokic V, et al. Local control and overall survival after frameless radiosurgery: a single center experience. Clin Transl Radiat Oncol. 2017;7:55–61.

    PubMed  PubMed Central  Google Scholar 

  4. Kirkpatrick JP, Wang Z, Sampson JH, McSherry M, Herndon JE, Allen KJ, et al. Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial. Int J Radiat Oncol Biol Phys. 2015;91(1):100–8.

    Article  PubMed  Google Scholar 

  5. Bennion NR, Malouff T, Verma V, Denniston K, Bhirud A, Zhen W, et al. A comparison of clinical and radiologic outcomes between frame-based and frameless stereotactic radiosurgery for brain metastases. Pract Radiat Oncol. 2016;6(6):e283–90.

    Article  PubMed  Google Scholar 

  6. Zhang SY, Zhu GY, Li G, Zhang YB, Geng JH. Application of stereotactic body radiation therapy to cancer liver metastasis. Cancer Lett. 2016;379(2):225–9.

    Article  CAS  PubMed  Google Scholar 

  7. Oh SA, Yea JW, Kang MK, Park JW, Kim SK. Analysis of the setup uncertainty and margin of the daily exactrac 6D image guide system for patients with brain tumors. PLoS One. 2016;11(3): e0151709.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ojerholm E, Anderson N, Patel K, Wang P, Lustig RA, Basanta MA, et al. Impact of image guidance during whole-brain radiation therapy. Pract Radiat Oncol. 2016;6(6):e345–51.

    Article  PubMed  Google Scholar 

  9. He DC, Zhu ZJ, Zhang XY, Zhang Y, Hong J, Shi TT, et al. Positioning error analysis of the fraxion localization system in the intracranial stereotactic radiotherapy of tumors. Clin Transl Oncol. 2021;23:43–7.

    Article  PubMed  Google Scholar 

  10. Naoi Y, Kunishima N, Yamamoto K, Yoda K. A planning target volume margin formula for hypofractionated intracranial stereotactic radiotherapy under cone beam CT image guidance with a six-degrees-offreedom robotic couch and a mouthpiece-assisted mask system: a preliminary study. Br J Radiol. 2014;87(1041):20140240.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Jhaveri J, Chowdhary M, Zhang X, Press RH, Switchenko JM, Ferris MJ, et al. Does size matter? investigating the optimal planning target volume margin for postoperative stereotactic radiosurgery to resected brain metastases. J Neurosurg. 2018;130(3):797–803.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Minniti G, Capone L, Alongi F, Figlia V, Nardiello B, Gawhary RE, et al. Initial experience with single-isocenter radiosurgery to target multiple brain metastases using an automated treatment planning software. Adv Radiat Oncol. 2020;5(5):856–64.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Baker BC, Sullivan TA. Trigeminal rhizotomy performed with modern image-guided linac: case report. Cureus. 2013;5(9): e139.

    Google Scholar 

  14. Freislederer P, Kügele M, Öllers M, Swinnen A, Sauer TO, Bert C, et al. Recent advanced in surface guided radiation therapy. Radiat Oncol. 2020;15(1):1–11.

    Google Scholar 

  15. Wei W, Ioannides PJ, Sehgal V, Daroui P. Quantifying the impact of optical surface guidance in the treatment of cancers of the head and neck. J Appl Clin Med Phys. 2020;21(6):73–82.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Li G, Ballangrud A, Chan M, Ma R, Beal K, Yamada Y, et al. Clinical experience with two frameless stereotactic radiosurgery (fSRS) systems using optical surface imaging for motion monitoring. J Appl Clin Med Phys. 2015;16(4):149–62.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wang H, Wang C, Tung S, Dimmitt AW, Wong PF, Edson MA, et al. Improved setup and positioning accuracy using a three-point customized cushion/mask/bite-block immobilization system for stereotactic reirradiation of head and neck cancer. J Appl Clin Med Phys. 2016;17(3):180–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fu L, Perera H, Ying X, Yu Y. Importance of CBCT setup verification for optical-guided frameless radiosurgery. J Appl Clin Med Phys. 2014;15(3):32–40.

    Article  PubMed Central  Google Scholar 

  19. Wiant D, Liu H, Hayes TL, Shang Q, Mutic S, Sintay B. Direct comparison between surface imaging and orthogonal radiographic imaging for SRS localization in phantom. J Appl Clin Med Phys. 2019;20(1):137–44.

    Article  PubMed  Google Scholar 

  20. Zhao B, Maquilan G, Jiang S, Schwartz DL. Minimal mask immobilization with optical surface guidance for head and neck radiotherapy. J Appl Clin Med Phys. 2018;19(1):17–24.

    Article  CAS  PubMed  Google Scholar 

  21. Jursinic P, Jordan K, Chen C. Positions of radiation isocenter and the couch rotation center established by Winston-Lutz and optical measurements. Tech Innov Patient Support Radiat Oncol. 2022;21:46–50.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Barnes M, Yeo A, Thompson K, Phillips C, Kron T, Hardcastle N. A retrospective analysis of setup and intrafraction positional variation in stereotactic radiotherapy treatments. J Appl Clin Med Phys. 2020;21(12):109–19.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Swinnen ACC, Öllers MC, Loon Ong C, Verhaegen F. The potential of an optical surface tracking system in non-coplanar single isocenter treatments of multiple brain metastases. J Appl Clin Med Phys. 2020;21(6):63–72.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bry V, Licon AL, McCulloch J, Kirby N, Myers P, Saenz D, et al. Quantifying false positional corrections due to facial motion using SGRT with open-face Masks. J Appl Clin Med Phys. 2021;22(4):172–83.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lee SK, Huang S, Zhang L, Ballangrud AM, Aristophanous M, Cervino Arriba LI, et al. Accuracy of surface-guided patient setup for conventional radiotherapy of brain and nasopharynx cancer. J Appl Clin Med Phys. 2021;22(5):48–57.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Li TT, Liu QF, Zhang T, Zhang Y, Zhang W, Chen H, et al. Accuracy of optical surface-guided hypo-fractionated radiotherapy for intracranial metastasis with open face mask immobilization. Chin J Radiat Oncol. 2022;31(8):722–6.

    Google Scholar 

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Acknowledgements

This work was financially supported by the National Natural Science Foundation of China (82272832).

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Author notes

  1. Xuemei Chen and Lu Liu have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China

    Xuemei Chen, Lu Liu, Yajuan Wang, Xiaotong Huang, Weixun Cai, Xiaodong Rong, Liuwen Lin, Jindi Liu & Xiaobo Jiang

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  1. Xuemei Chen
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Contributions

XMC and LL: contributed equally to this work. XBJ and JDL: designed and supervised the study. XBJ: conducted the innovation of the immobilization flow. XMC and LL: analyzed the data and wrote the manuscript. YJW, XTH, WXC, XDR and LWL: performed radiotherapy treatment and collected the clinical data.

Corresponding authors

Correspondence to Jindi Liu or Xiaobo Jiang.

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Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

Ethical approval

This study was approved by the hospital ethics committee and conducted in accordance with the tenets of the Declaration of Helsinki.

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Informed consent was obtained from the patient included in this study.

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Chen, X., Liu, L., Wang, Y. et al. Surface guided radiation therapy with an innovative open-face mask and mouth bite: patient motion management in brain stereotactic radiotherapy. Clin Transl Oncol 26, 424–433 (2024). https://doi.org/10.1007/s12094-023-03260-z

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  • DOI: https://doi.org/10.1007/s12094-023-03260-z

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