Research Article

Assessment of Multimodality Imaging Based Treatment Volume Determination for Stereotactic Body Radiation Therapy (SBRT) of Adrenal Metastases

Omer Sager*, Ferrat Dincoglan, Selcuk Demiral and Murat Beyzadeoglu

Department of Radiation Oncology; University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey

Submission: April 07, 2024; Published: May 10, 2024

*Corresponding Address: Omer Sager, Department of Radiation Oncology; University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey, Email: omersager@gmail.com

How to cite this article: Omer Sager*, Ferrat Dincoglan, Selcuk Demiral and Murat Beyzadeoglu. Assessment of Multimodality Imaging Based Treatment Volume Determination for Stereotactic Body Radiation Therapy (SBRT) of Adrenal Metastases. Canc Therapy & Oncol Int J. 2024; 26(5): 556198. DOI:10.19080/CTOIJ.2024.26.556198

Abstract

Objective: Adrenal gland constitutes a common site of metastasis from several cancers, and management of oligometastatic disease with sophisticated irradiation strategies such as Stereotactic Body Radiation Therapy (SBRT) has gained utmost attraction in recently. SBRT may serve as an excellent tool for management of oligometastatic adrenal disease. High doses of irradiation may be excellently focused on well-defined targets by use of SBRT under stereotactic localization, immobilization and image guidance. The dose is focused on the target and surrounding critical structures may be spared with SBRT owing to steep dose gradients around the target volume. In this study, we evaluated treatment volume determination for SBRT of adrenal metastases with comparative analysis of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI).

Materials and methods: For this study, the ultimate endpoint was treatment volume determination for SBRT of adrenal metastases by comparative analysis of CT and MRI.

Results: In this study, we found that CT and MRI defined treatment volume determination resulted in differences. Considering this, we made use of fused CT and MRI for ground truth treatment volume determination for SBRT of adrenal metastases.

Conclusion: Results of this study may have implications for increased adoption of multimodality imaging for treatment volume determination for SBRT of adrenal metastases, however, future studies may be required to shed light on this issue.

Keywords: Adrenal metastases; Stereotactic Body Radiation Therapy; Treatment volume determination; Immobilization; Stereotactic localization

Abbreviations: SBRT: Stereotactic Body Radiation Therapy; IGRT: Image Guided RT; ART: Adaptive RT; CT: Computed Tomography; MRI: Magnetic Resonance Imaging; LINAC: Linear Accelerator; AAPM: American Association of Physicists in Medicine; ICRU: International Commission on Radiation Units and Measurements

Introduction

Adrenal gland constitutes a common site of metastasis from several cancers, and management of oligometastatic disease with sophisticated irradiation strategies such as Stereotactic Body Radiation Therapy (SBRT) has gained utmost attraction in recently [1-7]. As a matter of fact, recent years have witnessed unprecedented advances in technology. Automatic segmentation techniques, molecular imaging methods, Image Guided RT (IGRT), Intensity Modulated RT (IMRT), stereotactic RT, and adaptive RT (ART) have been introduced for improved radiotherapeutic management of patients [8-49]. SBRT may serve as an excellent tool for management of oligometastatic adrenal disease as addressed in several studies [1-7]. High doses of irradiation may be excellently focused on well-defined targets by use of SBRT under stereotactic localization, immobilization and image guidance. The dose is focused on the target and surrounding critical structures may be spared with SBRT owing to steep dose gradients around the target volume. In this study, we evaluated treatment volume determination for SBRT of adrenal metastases with comparative analysis of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI).

Materials and Methods

We have been treating a high patient population from several places from Turkey and abroad for decades at our Department of Radiation Oncology at University of Health Sciences. With administration of state-of-the-art radiotherapy techniques, several benign and malignant tumors are irradiated. For this study, the ultimate endpoint was treatment volume determination for SBRT of adrenal metastases by comparative analysis of CT and MRI. All included patients have been referred to Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences for SBRT of adrenal metastases. We have performed a comparative analysis of treatment volume determination by CT simulation images for SBRT planning and with MRI. CT simulations of the patients have been performed at CT-simulator (GE Lightspeed RT, GE Healthcare, Chalfont St. Giles, UK) available at our department. Also, MRI of patients have been acquired and used for comparative assessment.

A Linear Accelerator (LINAC) with the capability of sophisticated IGRT techniques was used for SBRT. After rigid patient immobilization, planning CT images have been acquired at CT-simulator for SBRT planning. Afterwards, acquired SBRT planning images were sent to the contouring workstation via the network. Treatment volumes and critical structures were outlined on these images and structure sets have been generated. Also, treatment volume determination was also performed on MRI for comparison purposes. All patients underwent SBRT at Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences.

Results

Our study has selectively focused on assessment of treatment volume determination for SBRT of adrenal metastases with comparative analysis of CT and MRI. Stereotactic irradiation procedures were carried out at our Radiation Oncology Department of Gulhane Medical Faculty at University of Health Sciences, Ankara. Before SBRT, all included patients were individually assessed by a multidisciplinary team of experts from surgical oncology, radiation oncology, and medical oncology.

We considered the reports by American Association of Physicists in Medicine (AAPM) and International Commission on Radiation Units and Measurements (ICRU) for optimal SBRT planning. Radiation physicists took part in generation of SBRT treatment plans by considering relevant normal tissue dose constraints. Tissue heterogeneity, electron density, CT number and HU values in CT images have also been considered by radiation physicists for precise SBRT planning. Main goal of SBRT planning was to achieve optimal treatment volume coverage without violation of normal tissue dose constraints. IGRT techniques including kilovoltage cone beam CT has been utilized, and SBRT was delivered by Synergy (Elekta, UK) LINAC. We found that CT and MRI defined target volume definition resulted in differences as an important result of this current study. Considering this, we made use of fused CT and MRI for ground truth treatment volume determination for SBRT of adrenal metastases.

Discussion

Adrenal gland constitutes a common site of metastasis from several cancers, and management of oligometastatic disease with sophisticated irradiation strategies such as SBRT has gained utmost attraction in recently [1-7]. As a matter of fact, recent years have witnessed unprecedented advances in technology. Automatic segmentation techniques, molecular imaging methods, IGRT, IMRT, stereotactic RT, ART have been introduced for improved radiotherapeutic management of patients [8-49]. SBRT may serve as an excellent tool for management of oligometastatic adrenal disease as addressed in several studies [1-7]. High doses of irradiation may be excellently focused on well-defined targets by use of SBRT under stereotactic localization, immobilization and image guidance. The dose is focused on the target and surrounding critical structures may be spared with SBRT owing to steep dose gradients around the target volume. In this study, we evaluated treatment volume determination for SBRT of adrenal metastases with comparative analysis of CT and MRI.

We have been treating a high patient population from several places from Turkey and abroad for decades at our Department of Radiation Oncology at University of Health Sciences. With administration of state of the art radiotherapy techniques, several benign and malignant tumors are irradiated. For this study, the ultimate endpoint was treatment volume determination for SBRT of adrenal metastases by comparative analysis of CT and MRI. All included patients have been referred to Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences for SBRT of adrenal metastases. We have performed a comparative analysis of treatment volume determination by CT simulation images for SBRT planning and with MRI. CT simulations of the patients have been performed at CT-simulator (GE Lightspeed RT, GE Healthcare, Chalfont St. Giles, UK) available at our department. Also, MRI of patients have been acquired and used for comparative assessment.

A Linear Accelerator (LINAC) with the capability of sophisticated IGRT techniques was used for SBRT. After rigid patient immobilization, planning CT images have been acquired at CT-simulator for SBRT planning. Afterwards, acquired SBRT planning images were sent to the contouring workstation via the network. Treatment volumes and critical structures were outlined on these images and structure sets have been generated. Also, treatment volume determination was also performed on MRI for comparison purposes. All patients underwent SBRT at Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences.

Our study has selectively focused on assessment of treatment volume determination for SBRT of adrenal metastases with comparative analysis of CT and MRI. Stereotactic irradiation procedures were carried out at our Radiation Oncology Department of Gulhane Medical Faculty at University of Health Sciences, Ankara. Before SBRT, all included patients were individually assessed by a multidisciplinary team of experts from surgical oncology, radiation oncology, and medical oncology.

We considered the reports by American Association of Physicists in Medicine (AAPM) and International Commission on Radiation Units and Measurements (ICRU) for optimal SBRT planning. Radiation physicists took part in generation of SBRT treatment plans by considering relevant normal tissue dose constraints. Tissue heterogeneity, electron density, CT number and HU values in CT images have also been considered by radiation physicists for precise SBRT planning. Main goal of SBRT planning was to achieve optimal treatment volume coverage without violation of normal tissue dose constraints. IGRT techniques including kilovoltage cone beam CT has been utilized, and SBRT was delivered by Synergy (Elekta, UK) LINAC. We found that CT and MRI defined target volume definition resulted in differences as an important result of this current study. Considering this, we made use of fused CT and MRI for ground truth treatment volume determination for SBRT of adrenal metastases.

From the perspective of radiation oncology, optimal treatment volume determination and normal tissue sparing may be considered among the pertinent aspects of improved stereotactic irradiation. While definition of larger target volumes may result in un-towards toxicity, definition of smaller than actual target volumes may lead to consequent treatment failures. Adaptive RT strategies and multimodality imaging-based target determination has been suggested for addressing this critical issue [50-106].

In this study, we found that CT and MRI defined treatment volume determination resulted in differences. Considering this, we made use of fused CT and MRI for ground truth treatment volume determination for SBRT of adrenal metastases. Results of this study may have implications for increased adoption of multimodality imaging for treatment volume determination for SBRT of adrenal metastases, however, future studies may be required to shed light on this issue.

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67. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2020) Multimodality Imaging Based Target Definition of Cervical Lymph Nodes in Precise Limited Field Radiation Therapy (Lfrt) for Nodular Lymphocyte Predominant Hodgkin Lymphoma (Nlphl). ARC J Cancer Sci 6: 6-11.
68. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2020) Radiosurgery Treatment Volume Determination for Brain Lymphomas with and without Incorporation of Multimodality Imaging. J Med Pharm Allied Sci 9: 2398-2404.
69. Beyzadeoglu M, Dincoglan F, Sager O, Demiral S (2020) Determination of Radiosurgery Treatment Volume for Intracranial Germ Cell Tumors (GCTS). Asian J Pharm Nurs Med Sci 8(3): 18-23.
70. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2020) Target Definition of orbital Embryonal Rhabdomyosarcoma (Rms) by Multimodality Imaging: An Original Article. ARC J Cancer Sci 6(2): 12-17.
71. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2020) Evaluation of Target Volume Determination for Irradiatıon of Pilocytic Astrocytomas: An Original Article. ARC J Cancer Sci 6: 1-5.
72. Demiral S, Beyzadeoglu M, Dincoglan F, Sager O (2020) Evaluation of Radiosurgery Target Volume Definition for Tectal Gliomas with Incorporation of Magnetic Resonance Imaging (MRI): An Original Article. Biomed J Sci & Techn Res (BJSTR) 27: 20543-20547.
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76. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2021) Radiation Therapy (RT) Target Volume Definition for Peripheral Primitive Neuroectodermal Tumor (PPNET) by Use of Multimodality Imaging: An Original Article. Biomed J Sci & Tech Res 34: 26970-26974.
77. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2021) Evaluation of Target Definition for Management of Myxoid Liposarcoma (MLS) with Neoadjuvant Radiation Therapy (RT). Biomed J Sci Tech Res 33: 26171-26174.
78. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2021) Radiation Therapy (RT) target determination for irradiation of bone metastases with soft tissue component: Impact of multimodality imaging. J Surg Surgical Res 7: 42-46.
79. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2021) Evaluation of Changes in Tumor Volume Following Upfront Chemotherapy for Locally Advanced Non-Small Cell Lung Cancer (NSCLC). Glob J Cancer Ther 7: 31-34.
80. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2021) Assessment of posterior fossa target definition by multimodality imaging for patients with medulloblastoma. J Surg Surgical Res 7: 37-41.
81. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2021) Assessment of the role of multimodality imaging for treatment volume definition of intracranial ependymal tumors: An original article. Glob J Cancer Ther 7: 43-45.
82. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2022) Assessment of Target Definition for Extramedullary Soft Tissue Plasmacytoma: Use of Multımodalıty Imaging for Improved Targetıng Accuracy. Canc Therapy & Oncol Int J 22(4): 556095.
83. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2022) Target Volume Determination for Recurrent Uterine Carcinosarcoma: An Original Research Article Revisiting the Utility of Multimodality Imaging. Canc Therapy & Oncol Int J 22(3): 556090.
84. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2022) Reappraisal of Computed Tomography (CT) And Magnetic Resonance Imaging (MRI) Based Target Definition for Radiotherapeutic Management of Recurrent Anal Squamous Cell Carcinoma (ASCC): An Original Article. Canc Therapy & Oncol Int J 22(2): 556085.
85. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2022) An Original Article for Assessment of Multimodality Imaging Based Precise Radiation Therapy (Rt) in the Management of Recurrent Pancreatic Cancers. Canc Therapy & Oncol Int J 22(1): 556078.
86. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2022) Assessment of Target Volume Definition for Precise Radiotherapeutic Management of Locally Recurrent Biliary Tract Cancers: An Original Research Article. Biomed J Sci & Tech Res 46(1): 37054-37059.
87. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M. (2022) Radiation Therapy (RT) Target Volume Determination for Locally Advanced Pyriform Sinus Carcinoma: An Original Research Article Revisiting the Role of Multimodality Imaging. Biomed J Sci & Tech Res 45(1): 36155-36160.
88. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2022) Improved Target Volume Definition for Radiotherapeutic Management of Parotid Gland Cancers by use of Multimodality Imaging: An Original Article. Canc Therapy & Oncol Int J 21(3): 556062.
89. Beyzadeoglu M, Sager O, Demiral S, Dincoglan F (2022) Reappraisal of multimodality imaging for improved Radiation Therapy (RT) target volume determination of recurrent Oral Squamous Cell Carcinoma (OSCC): An original article. J Surg Surgical Res 8: 4-8.
90. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2022) Multimodality imaging-based treatment volume definition for recurrent Rhabdomyosarcomas of the head and neck region: An original article. J Surg Surgical Res 8(2): 13-18.
91. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2022) Appraisal of Target Definition for Management of Paraspinal Ewing Tumors with Modern Radiation Therapy (RT): An Original Article. Biomed J Sci & Tech Res 44(4): 35691-35696.
92. Beyzadeoglu M, Sager O, Demiral S, Dincoglan F (2022) Assessment of Target Volume Definition for Contemporary Radiotherapeutic Management of Retroperitoneal Sarcoma: An Original Article. Biomed J Sci & Tech Res 44(5): 35883-35887.
93. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2023) Appraisal of Target Definition for Anaplastic Thyroid Carcinoma (ATC): An Original Article Addressing the Utility of Multimodality Imaging. Canc Therapy & Oncol Int J 24(4): 556143.
94. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2023) Reappraisal of Treatment Volume Determination for Parametrial Boosting in Patients with Locally Advanced Cervical Cancer. Canc Therapy & Oncol Int J 24(5): 556148.
95. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2023) Tumor Size Changes after Neoadjuvant Systemic Therapy for Advanced Oropharyngeal Squamous Cell Carcinoma. Canc Therapy & Oncol Int J 24(5): 556147.
96. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2023) Assessment of Changes in Tumor Volume Following Chemotherapy for Nodular Sclerosıng Hodgkin Lymphoma (NSHL). Canc Therapy & Oncol Int J 24(5): 556146.
97. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2023) Evaluation of Volumetric Changes in Transglottic Laryngeal Cancers After Induction Chemotherapy. Biomed J Sci & Tech Res 51(4): 43026-43031.
98. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2023) An Original Research Article for Evaluation of Changes in Tumor Size After Neoadjuvant Chemotherapy in Borderline Resectable Pancreatic Ductal Adenocarcinoma. Biomed J Sci & Tech Res 52(1): 43253-43255.
99. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2023) Assessment of Tumor Size Changes After Neoadjuvant Chemotherapy in Locally Advanced Esophageal Cancer: An Original Article. Biomed J Sci & Tech Res 52(2): 43491-43493.
100. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2023) Evaluation of Target Definition for Radiotherapeutic Management of Recurrent Merkel Cell Carcinoma (MCC). Canc Therapy & Oncol Int J 24(2): 556133.
101. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2023) Reappraisal of Treatment Volume Determination for Recurrent Gastroesophageal Junction Carcinoma (GJC). Biomed J Sci & Tech Res 50(5): 42061-42066.
102. Beyzadeoglu M, Dincoglan F, Demiral S, Sager O (2023) An Original Article Revisiting the Utility of Multimodality Imagıng for Refıned Target Volume Determinatıon Of Recurrent Kidney Carcinoma. Canc Therapy & Oncol Int J 23(5): 556122.
103. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2023) Appraisal of Target Definition for Recurrent Cancers of the Supralottic Larynx. Biomed J Sci & Tech Res 50 (5): 42131-42136.
104. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2024) Reappraisal of Target Definition for Sacrococcygeal Chordoma: Comparative Assessment with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Biomed J Sci & Tech Res 55(1): 46686-46692.
105. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2024) Assessment of Changes in Tumor Size After Induction Systemic Therapy for Locally Advanced Cervical Squamous Cell Carcinoma Running title: Tumor size changes in cervical carcinoma. Cancer Ther Oncol Int J 26(1): 1-7.
106. Dincoglan F, Beyzadeoglu M, Demiral S, Sager O (2024) Appraisal of Changes in Tumor Volume After Neoadjuvant Systemic Therapy for Hepatocellular Carcinoma (HCC). Cancer Ther Oncol Int J 26(2): 1-4.