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Watcharawipha A, Chakrabandhu S, Kongsa A, Tippanya D, Chitapanarux I. Plan quality analysis of stereotactic ablative body radiotherapy treatment planning in liver tumor. J Appl Clin Med Phys 2023:e13948. [PMID: 36857202 DOI: 10.1002/acm2.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Stereotactic ablative body radiotherapy (SABR) in the liver, RTOG-1112 guides the treatment modalities including the dose constraints for this technique but not the plan parameters. This study is not only analyzing the plan quality by utilizing the plan parameters and indexes but also compares treatment modalities from the protocol implementation. METHOD AND MATERIAL Twenty-five patients treated in the period from February 2020 to September 2022 were recruited in this analysis. Two planners randomly selected the patients and modalities. The modalities employed were Volumetric-Modulated Arc Therapy (VMAT) and Helical Tomotherapy (HT). Various parameters and indexes were used to access not only the plan quality but also to compare each modality. The parameters and indexes studied were the homogeneity index (HI), conformity index (CI), gradient distance (GD), and the dose received by the organs at risk. RESULT The data reveals that the mean volume of PTV is 60.8 ± 53.9 cc where these targets exhibit no significant difference between each modality. The HI shows a consistent value for both modalities. Between each modality, the CI value shows less deviation, but the HT shows slightly higher performance than VMAT. The value of GD is 1.5 ± 0.3 cm where the HT provides a shorter distance compared to VMAT as well. CONCLUSION The parameters and indexes should be utilized for the plan evaluation although in the guidelines this was not required. Various modalities were employed for treatment. Both can achieve the treatment criteria with slightly low performance of VMAT.
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Affiliation(s)
- Anirut Watcharawipha
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anupong Kongsa
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Damrongsak Tippanya
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Shen J, Wang Y, Wang L, Gu P, Wang Z. Dosimetric effects of the custom dose iteration times on stereotactic radiotherapy for lung cancer. Radiat Phys Chem Oxf Engl 1993 2023. [DOI: 10.1016/j.radphyschem.2023.110882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Mesny E, Ayadi M, Dupuis P, Beldjoudi G, Tanguy R, Martel-Lafay I. Clinical outcomes and lung toxicities after lung SABR using dynamic conformal arc therapy: a single-institution cohort study. Radiat Oncol 2023; 18:36. [PMID: 36814265 PMCID: PMC9948312 DOI: 10.1186/s13014-023-02227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Stereotactic ablative radiotherapy (SABR) is a validated treatment for early stage lung cancer and pulmonary metastases. It provides a high local control rate with low symptomatic toxicities. Recently, Dynamic Conformal Arc Therapy (DCAT), a delivery option that differs from conventional DCA, has been implemented in the Monaco Treatment Planning System for SABR. The aim of the study was to report clinical outcomes and toxicities for patients treated for lung SABR with this new technique. METHODS We retrospectively identified adult patients treated for primary or secondary lung tumors with DCAT-SABR and reported their clinical, radiological, histological characteristics and dosimetric parameters. Total dose was delivered in 3 or 5 fractions for 95% of patients and prescribed on the 80% isodose line to the PTV periphery. RESULTS 145 patients met inclusion criteria for a total of 152 lesions with a median follow up of 12 months. Local control for the irradiated site was 96.7% at 1 year. Overall survival was 93.1% at 1 year. Mean prescription dose in BED10 was 110 Gy. 92% of patients had a prescribed dose superior to 100 Gy BED10. Mean PTV coverage was 95.1%. There were 66 cases of grade 1 radiation pneumonitis (RP) (43%) and only 7 cases of symptomatic grade 2 RP (4.6%). CONCLUSION Lung SABR for primary or metastatic lung tumors using dynamic conformal arc therapy provides efficient results of local control and low lung toxicities, similar to other SABR techniques. ADVANCES IN KNOWLEDGE SABR using DCAT is a safe technique to treat lung lesions, allowing intra-fraction motion limitation, potentially higher OARs protection and a shortened beam delivery.
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Affiliation(s)
- Emmanuel Mesny
- Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France.
| | - Myriam Ayadi
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Pauline Dupuis
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Guillaume Beldjoudi
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Ronan Tanguy
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Isabelle Martel-Lafay
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
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Tang C, Gong C, Liu B, Guo H, Dai Z, Yuan J, Wang X, Zhang Y. Feasibility and dosimetric evaluation of single- and multi-isocentre stereotactic body radiation therapy for multiple liver metastases. Front Oncol 2023; 13:1144784. [PMID: 37188200 PMCID: PMC10175834 DOI: 10.3389/fonc.2023.1144784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Objectives Single-isocentre volumetric-modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) improves treatment efficiency and patient compliance for patients with multiple liver metastases (MLM). However, the potential increase in dose spillage to normal liver tissue using a single-isocentre technique has not yet been studied. We comprehensively evaluated the quality of single- and multi-isocentre VMAT-SBRT for MLM and propose a RapidPlan-based automatic planning (AP) approach for MLM SBRT. Methods A total of 30 patients with MLM (two or three lesions) were selected for this retrospective study. We manually replanned all patients treated with MLM SBRT by using the single-isocentre (MUS) and multi-isocentre (MUM) techniques. Then, we randomly selected 20 MUS and MUM plans for training to generate the single-isocentre RapidPlan model (RPS) and the multi-isocentre RapidPlan model (RPM). Finally, we used data from the remaining 10 patients to validate RPS and RPM. Results Compared with MUS, MUM reduced the mean dose delivered to the right kidney by 0.3 Gy. The mean liver dose (MLD) was 2.3 Gy higher for MUS compared with MUM. However, the monitor units, delivery time, and V20Gy of normal liver (liver-gross tumour volume) for MUM were significantly higher than for MUS. Based on validation, RPS and RPM slightly improved the MLD, V20Gy, normal tissue complications, and dose sparing to the right and left kidneys and spinal cord compared with manual plans (MUS vs RPS and MUM vs RPM), but RPS and RPM significantly increased monitor units and delivery time. Conclusions The single-isocentre VMAT-SBRT approach could be used for MLM to reduce treatment time and patient comfort at the cost of a small increase in the MLD. Compared with the manual plans, RapidPlan-based plans, especially RPS, have slightly improved quality.
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Affiliation(s)
- Chunbo Tang
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Changfei Gong
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, China
- *Correspondence: Changfei Gong, ; Yun Zhang,
| | - Biaoshui Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hailiang Guo
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Zhongyang Dai
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Jun Yuan
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xiaoping Wang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, China
| | - Yun Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, China
- *Correspondence: Changfei Gong, ; Yun Zhang,
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Lee JN, Huelskamp C, Nappi C, Lenards N, Hunzeker A, Cetnar A. A dosimetric comparison of 3D DCAT vs VMAT for palliative and early-stage liver lesions using eclipse TPS. Med Dosim 2022; 47:252-257. [DOI: 10.1016/j.meddos.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/27/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
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Srivastava A, Parambath HK, Ramdulari AV, Saxena H, Kumar R, Pandey S, Shalimar, Gupta S, Jee B. Is hepatocellular carcinoma complicated with portal vein tumor thrombosis potentially curable by radiotherapy in the form of stereotactic body radiation therapy? Int J Radiat Biol 2022; 98:1495-1509. [PMID: 35311612 DOI: 10.1080/09553002.2022.2055800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal. Despite best treatment and care, the patients with this malignancy only showed 2.7-4 months of overall survival. It is debatable whether liver transplantation helps PVTT sufferers. The effectiveness of radiation therapy in treating HCC patients with PVTT should not be undervalued. By limiting the high dosage region to a small planning target volume, stereotactic radiation delivery has shifted toward hypofractionation, limiting the radiation exposure to healthy organs and tissues. Stereotactic body radiotherapy (SBRT) has a local control rate of 75-100%, depending on the treatment. The major limitation in SBRT for hepatocellular carcinoma with PVTT is the paucity of prospective evidence for longer periods beyond the first two years after treatment. More prospective studies/randomized clinical trials with a longer follow-up, larger sample size, and adequate statistical power are the dire need of the present situation to ascertain the curative effect of SBRT as primary therapy for advanced HCC with PVTT. CONCLUSION SBRT can improve survival, particularly for patients receiving multidisciplinary treatment. This review sums up our most current understanding of how radiation therapy, notably SBRT, can be used to treat hepatocellular carcinoma when combined with PVTT. Recent research has led us to believe that irradiation in the form of SBRT may cure hepatocellular carcinoma complicated by PVTT.
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Affiliation(s)
- Astha Srivastava
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Haresh Kunhi Parambath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjali V Ramdulari
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Saxena
- Department of Medicine Trauma, All India Institute of Medical Sciences, New Delhi, India
| | - Rishabh Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suyash Pandey
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Babban Jee
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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Durmus IF, Okumus A. Dosimetric comparison of mDCAT and VMAT techniques according to 6MV-FFF and 10MV-FFF energies in patients with single adrenal metastasis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:1023-1032. [PMID: 35848004 DOI: 10.3233/xst-221192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare dosimetric and radiobiological terms of modified dynamic conformal arc therapy (mDCAT) and volumetric modulated arc therapy (VMAT) techniques using different flattening-filter free (FFF) energies in patients with single adrenal metastasis. METHODS In this study, plans were prepared for 10 patients drawing on the mDCAT and VMAT techniques with 6MV-FFF and 10MV-FFF energies. Target volume doses, biological effective doses (BED), quality indices, Monitor Unit (MU), number of segments, beam-on time and critical organ doses were compared in the plans. RESULTS Plans with the significantly lower gradient index (GI) and conformity index (CI) values were obtained with 6MV-FFF energy VMAT planning (p < 0.05). The higher values were obtained for dose to 95% of internal target volume (ITVD95), ITVD95-BED10 with 10MV-FFF energy VMAT planning, whereas lower results were obtained for high dose spillage (HDS%) values (p < 0,05). With 10MV-FFF energy, HDS% values were 21.1% lower in VMAT plans and 5.6% lower in mDCAT plans compared to 6MV-FFF energy. Plans with approximately 50% fewer segments were obtained in mDCAT plans than VMAT plans (p < 0,05). Beam-on time values with mDCAT was 1.84 times lower when 6MV-FFF energies were analyzed, and 2.11 times lower when 10MV-FFF was analyzed (p < 0,05). Additionally, when 6MV-FFF and 10MV-FFF energies were examined, MU values with mDCAT were 2.1 and 2.5 times lower (p < 0,05). In general, the smaller the target volume size, the greater the differences between MU and beam-on time values mDCAT and VMAT. CONCLUSIONS The study results implied that VMAT enabled to offer significantly more conformal SBRT plans with steeper dose fall-off beyond the target volume for single adrenal metastasis than the mDCAT, which attained at the cost of significantly higher MU and beam-on times. Especially with 10MV-FFF energy mDCAT plans, low-dose-bath zones can be reduced, and shorter-term treatments can be implemented with large segments. In adrenal gland SBRT, higher effective doses can be achieved with the right energy and technique, critical organ doses can be reduced, thus increasing the possibility of local control of the tumor with low toxicity.
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Affiliation(s)
- Ismail Faruk Durmus
- Department of Radiation Oncology, Nisantasi University, Istanbul, Turkey
- Department of Radiation Oncology, Yeni Yuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Ayse Okumus
- Department of Radiation Oncology, Nisantasi University, Istanbul, Turkey
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Thaper D, Yadav HP, Sharma D, Kamal R, Singh G, Oinam AS, Kumar V. Degree of reduction in normal liver complication probability from free-breathing to breath-hold liver SBRT: a dose-escalation strategy using radiation dose-volume effect. Biomed Phys Eng Express 2021; 8. [PMID: 34874286 DOI: 10.1088/2057-1976/ac3fe5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 11/12/2022]
Abstract
Introduction. This study aimed to analyze the degree of reduction in normal liver complication probability (NTCP) from free-breathing (FB) to breath-hold (BH) liver SBRT. The effect of the radiation dose-volume on the mean liver dose (MLD) was also analyzed due to dose prescription, normal liver volume (NLV), and PTV.Materials and Methods. Thirty-three stereotactic body radiation therapy (SBRT) cases of hepatocellular carcinoma were selected, retrospectively. For FB, the treatments were planned on average intensity projection scan (CTavg), and patient-specific internal target volume (ITV) margins were applied. To simulate the BH treatment, computed tomography (CT) scan correspond to the 40%-50% of the respiratory cycle (CT40%-50%) was chosen, and an appropriate intrafraction margin of 2 mm, 1.5 mm, and 1.5 mm were given in craniocaudal (CC), superior-inferior (SI), and lateral direction to generate the final iGTV. As per RTOG 1112, all organs at risk (OAR's) were considered during the optimization of treatment plans. NTCP was calculated using LKB fractionated model. Multivariate regression analysis was performed to see the effect of EQD2Gy, NLV, and PTV on MLD2Gy.Results.A significant dosimetric difference was observed in the normal liver (liver-ITV/iGTV). A reduction of 1.7% in NTCP was observed from FB to BH technique. The leverage of dose escalation is more in BH because MLD2Gycorresponds to 5%, 10%, 20%, and 50% NTCP was 0.099 Gy, 0.41 Gy, 1.21 Gy, and 3.432 Gy more in BH as compared to FB technique. In MVRA, the major factor which was attributed to a change in MLD2Gyis EQD2Gy. Conclusion. From FB to BH technique, a significant reduction in NTCP was observed. The dose prescription is a major factor attributed to the change in MLD2Gy. Advances in knowledge: If feasible, prefer BH treatment either for tumor dose escalation or for the reduction in NTCP.
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Affiliation(s)
- Deepak Thaper
- Centre for Medical Physics, Panjab University, Chandigarh, India.,Radiation Oncology Department, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Hanuman P Yadav
- Radiation Oncology Department, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Deepti Sharma
- Radiation Oncology Department, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rose Kamal
- Centre for Medical Physics, Panjab University, Chandigarh, India.,Radiation Oncology Department, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gaganpreet Singh
- Centre for Medical Physics, Panjab University, Chandigarh, India.,Radiotherapy Department, PGIMER, Regional Cancer Centre, Chandigarh, India
| | - Arun S Oinam
- Radiotherapy Department, PGIMER, Regional Cancer Centre, Chandigarh, India
| | - Vivek Kumar
- Centre for Medical Physics, Panjab University, Chandigarh, India
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Kumar R, Yadav HP, Thaper D, Kamal R, Gupta A, Kirti S. Efficacy and toxicity of SBRT in advanced hepatocellular carcinoma with portal vein tumor thrombosis - a retrospective study. REPORTS OF PRACTICAL ONCOLOGY AND RADIOTHERAPY : JOURNAL OF GREATPOLAND CANCER CENTER IN POZNAN AND POLISH SOCIETY OF RADIATION ONCOLOGY 2021; 26:573-581. [PMID: 34434573 DOI: 10.5603/rpor.a2021.0048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the outcome of stereotactic body radiation therapy (SBRT) in patients of unresectable hepatocellular carcinoma (HCC ) complicated with portal vein tumor thrombosis (PVTT) who are also unsuitable for other locoregional therapies. MATERIALS AND METHODS Between May 2018 and January 2020, twenty-nine patients with advanced unresectable HCC s, treated with SBRT, were enrolled in this retrospective audit. Patients of Child status A5-B7 and with healthy liver volume, ≥ 700 ccs were treated. Local control (LC), overall survival (OS), progression-free survival (PFS), PVTT opening rate, and effect of prognostic factors were analyzed. RESULTS The median tumor diameter was 8.6 cm (5-14), and the median tumor volume was 275 cc (151-1196). The median SBRT dose prescription was 48 Gy in 6 fractions (32-50 Gy in 5-6 fractions). The median follow up was eight months (1-20), 1-year local control, progression-free survival, and overall survival were 95%, 53.4%, and 60%, respectively. Overall rate of grade III toxicity was less than 5%, and the most common toxicity was lymphocytopenia. Tumors of more than 350cc had worse OS and PFS when compared to tumors < 350 cc (median OS and PFS of tumors > 350 cc was 4 months and two months, p = .01 and .003, respectively). A total of fifteen patients progressed with the disease and the median time to progression was two months [1-4]. CONCLUSION SBRT is safe and provides excellent local control in advanced HCC complicated with PVTT. The out of field failure pattern and time to failure in these patients highlights the need for adjuvant systemic therapy after completion of local treatment. Our data warrant the need for multimodality trials in this patient cohort.
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Affiliation(s)
- Rishabh Kumar
- Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Deepak Thaper
- Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rose Kamal
- Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Anil Gupta
- Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S Kirti
- Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
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Kamal R, Thaper D, Kumar R, Singh G, Yadav HP, Oinam AS, Kumar V, Sharma H. Dosimetric impact of contrast-enhanced 4d computed tomography for stereotactic body radiation therapy of hepatocelluar carcinoma. Rep Pract Oncol Radiother 2021; 26:598-604. [PMID: 34434576 PMCID: PMC8382070 DOI: 10.5603/rpor.a2021.0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/27/2021] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND A purpose of the study was to investigate the dosimetric impact of contrast media on dose calculation using average 4D contrast-enhanced computed tomography (4D-CECT) and delayed 4D-CT (d4D-CT) images caused by CT simulation contrast agents for stereotactic body radiation therapy (SBRT) of liver cases. MATERIALS AND METHODS Fifteen patients of liver SBRT treated using the volumetric modulated arc therapy (VMAT) technique were selected retrospectively. 4D-CECT, and d4D-CT were acquired with the Anzai gating system and GE CT. For all patients, gross target volume (GTV) was contoured on the ten phases after rigid registration of both the contrast and delayed scans and merged to generate internal target volume (ITV) on average CT images. Region of interest (ROI) was drawn on contrast images and then copied to the delayed images after rigid registration of two average CT datasets. The treatment plans were generated for contrast enhanced average CT, delayed average CT and contrast enhanced average CT with electron density of the heart overridden. RESULTS No significant dosimetric difference was observed in plans parameters (mean HU value of the liver, total monitor units, total control points, degree of modulation and average segment area) except mean HU value of the aorta amongst the three arms. All the OARs were evaluated and resulted in statistically insignificant variation (p > 0.05) using one way ANOVA analysis. CONCLUSIONS Contrast enhanced 4D-CT is advantageous in accurate delineation of tumors and assessing accurate ITV. The treatment plans generated on average 4D-CECT and average d4D-CT have a clinically insignificant effect on dosimetric parameters.
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Affiliation(s)
- Rose Kamal
- Centre for Medical Physics, Panjab University, Chandigarh, India
- Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Deepak Thaper
- Centre for Medical Physics, Panjab University, Chandigarh, India
- Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rishabh Kumar
- Centre for Medical Physics, Panjab University, Chandigarh, India
| | - Gaganpreet Singh
- Centre for Medical Physics, Panjab University, Chandigarh, India
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Regional Cancer Centre, Chandigarh, India
| | - Hanuman P. Yadav
- Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Arun S. Oinam
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Regional Cancer Centre, Chandigarh, India
| | - Vivek Kumar
- Centre for Medical Physics, Panjab University, Chandigarh, India
| | - Hitesh Sharma
- Govt. Cancer Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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