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

• Type of Material: Article
• Authors: Tahir Yusufaly, University of California San Diego; Austin Miller, Roswell Park Cancer Institute; Ana Medina-Palomo, University of California San Diego; Casey W Williamson, University of California San Diego; Nguyen Hannah, IROC Houston QA Center; Jessica Lowenstein, IROC Houston QA Center; Charles A Leath, University of Alabama Birmingham; Ying Xiao, University of Pennsylvania; Kevin L Moore, University of California San Diego; Katherine M Moxley, University of Oklahoma; Carlos M Chevere-Mourino, University of Puerto Rico; Tony Eng, Emory University; Tarrick Zaid, Houston Methodist Hospital; Loren K Mell, University of California San Diego
• Language: English
• Date: 2020-12-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijrobp.2020.06.071
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
• Volume: 108
• Issue: 5
• Start Page: 1240
• End Page: 1247
• Grant/Funding Information: This work was supported by National Cancer Institute (NCI) grants to Dr Mell and Dr Moore (1R01CA197059-01), NRG Oncology (U10 CA180822), NRG Operations (U10 CA180868), NCI Community Oncology Research Program (NCORP) (UG1CA189867), and Imaging and Radiation Oncology Core (IROC) (U24CA180803).
• Keywords: CERVICAL-CANCER; Oncology; Science & Technology; DOSIMETRIC PREDICTORS; SEGMENTATION; CHEMORADIATION; ACUTE HEMATOLOGIC TOXICITY; Radiology, Nuclear Medicine & Medical Imaging; CONCURRENT CISPLATIN; Life Sciences & Biomedicine

Abstract

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 18F-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] cm3) were slightly larger than custom ABM volumes (535.1 [93.2] cm3), with a Dice similarity coefficient of 0.73. Total pelvic bone marrow V20 and Dmean were systematically higher and custom ABM V10 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.