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Iwana-Yamada M, Shibamoto Y, Baba F, Iwata H, Ishikura S, Nagayoshi J, Hiwatashi A, Ogino H. Dose Prescription to Isodose Lines in Static Multi-Beam Stereotactic Body Radiotherapy for Lung Tumors: Which Line Is Optimal? Kurume Med J 2024; 69:217-226. [PMID: 38233174 DOI: 10.2739/kurumemedj.ms6934016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
This study investigated the appropriate dose prescription method in static multi-beam stereotactic body radiotherapy for lung tumors. Static multi-beam stereotactic body radiotherapy is a mainstream treatment in Japan. Based on the hypothesis that dose prescription to lower isodose lines may improve planning target volume dose coverage and decrease doses to organs at risk, we investigated changes in dose-volume histograms with prescription to various isodose lines for planning target volume in static multi-beam stereotactic body radiotherapy. In all treatment plans, 45 Gy in 4 fractions were prescribed to 95% of the planning target volume. By adjusting the leaf margins of each beam, various prescription isodose lines encompassing 95% volume of the planning target volume were generated. The prescription isodose lines investigated were 40, 50, 60, 70, 80 and 90% lines relative to the maximum dose of each planning target volume. The conformity index, homogeneity index, mean lung dose, and V5-V40 of the lung were evaluated. The dose was calculated by the adaptive convolve algorithm. The conformity index was lowest in the 70% or 80% isodose plan. The mean lung doses and V10-V40 of the lung decreased steeply from the 90% to the 70% isodose plan, and was lowest in the 60% and 70% isodose plans. These indices increased in the 40% and 50% isodose plans. The optimal stereotactic body radiotherapy plans appeared to be dose prescription to the 60% or 70% isodose line. Further investigation is warranted to clarify the advantage of using this method clinically.
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Affiliation(s)
- Maho Iwana-Yamada
- Department of Radiotherapy, Nagoya Proton Therapy Center
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Fumiya Baba
- Department of Radiotherapy, Nagoya Proton Therapy Center
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Junpei Nagayoshi
- Department of Radiological Technology, Nagoya City University West Medical Center
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
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The tumor core boost study: A feasibility study of radical dose escalation to the central part of large tumors with an integrated boost in the palliative treatment setting. Strahlenther Onkol 2023; 199:258-267. [PMID: 35857073 PMCID: PMC9938025 DOI: 10.1007/s00066-022-01976-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE For patients with large tumors palliative radiotherapy often is the only local treatment option. To prevent toxicity the administered doses are low. Dose escalation to the tumor could be an option to better smyptom control and prolong local control rates. In this prospective study we used a very pragmatic approach with a simultaneously integrated boost (SIB) to an almost geometrically defined tumor core to achieve this. The primary endpoint was to demonstrate feasibility. METHOD Patients with solid tumors > 4 cm in diameter of different histologies were eligible in this single arm, prospective, multi-institutional clinical feasibility trial with two treatment concepts: 5 × 5 Gy with an integrated boost to the tumor core of 5 × 10 Gy or 10 × 3 Gy with a boost of 10 × 6 Gy. The objective of dose escalation in this study was to deliver a minimum dose of 150% of the prescribed dose to the gross tumor volume (GTV) tumor core and to reach a maximum of at least 200% in the tumor core. RESULTS In all, 21 patients at three study sites were recruited between January 2019 and November 2020 and were almost evenly spread (9 to 12) between the two concepts. The treated planning target volumes (PTV) averaged 389.42 cm3 (range 49.4-1179.6 cm3). The corresponding core volumes were 72.85 cm3 on average (range 4.21-338.3 cm3). Dose escalation to the tumor core with mean doses of 167.7-207.7% related to the nonboost prescribed isodose led to PTV mean doses of 120.5-163.3%. Treatment delivery and short-term follow-up was successful in all patients. CONCLUSIONS Palliative radiotherapy with SIB to the tumor core seems to be a feasible and well-tolerated treatment concept for large tumors. The applied high doses of up to 50 Gy in 5 fractions (or 60 Gy in 10 fractions) did not cause unexpected side effects in the 42 day follow-up period. Further research is needed for more information on efficacy and long-term toxicity.
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Fujiwara M, Kitada F. Clinical Experience of Intra-tumoral Central-Dose Escalated Volumetric Modulated Arc Therapy for Lymph Node Metastases in Patients With Advanced Cancer. Cureus 2023; 15:e34995. [PMID: 36938256 PMCID: PMC10020031 DOI: 10.7759/cureus.34995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Background Lymph node metastases (LN mets) are radioresistant, and high-dose irradiation is preferred for their control. The volumetric-modulated arc therapy technique makes it possible to perform intra-tumoral dose escalation without increasing the total prescribed dose of fractionated irradiation. We report its clinical experiences with intra-tumoral central-dose escalated volumetric-modulated arc therapy (ICE-VMAT) for LN mets. Materials and methods This study retrospectively evaluated 31 patients with 50 LN mets from stage III and IV advanced cancers who received ICE-VMAT. The total described dose was 50 Gy, and the median intra-tumoral central dose was 66 Gy (range, 54-79 Gy). Results The median follow-up period was 21 months. The two-year local control and overall survival (OS) rates were 95% and 56%, whereas univariate analysis revealed that the KPS ≥ 80 group had a significantly better OS compared to the KPS < 80 group. Conclusion ICE-VMAT was effective for LN mets. Patients with good KPS may benefit from therapeutic intervention with ICE-VMAT, even if they have multiple distant LN mets.
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Savanović M, Loi M, Rivin Del Campo E, Huguet F, Foulquier JN. Assessment of Organ Dose Reduction Using Dynamic Conformal Arc and Static Field with FFF Beams for SBRT in Lung Cancer. Cancer Invest 2022; 40:868-878. [DOI: 10.1080/07357907.2022.2103705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Milovan Savanović
- Faculty of Medicine, University of Paris-Saclay, Le Kremlin-Bicetre, France
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Mauro Loi
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Eleonor Rivin Del Campo
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
- Faculty of Medicine, Sorbonne University Medical Faculty, Paris, France
| | - Florence Huguet
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
- Faculty of Medicine, Sorbonne University Medical Faculty, Paris, France
| | - Jean-Noël Foulquier
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
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Hellerbach A, Eichner M, Rueß D, Luyken K, Hoevels M, Judge M, Baues C, Ruge M, Kocher M, Treuer H. Impact of prescription isodose level and collimator selection on dose homogeneity and plan quality in robotic radiosurgery. Strahlenther Onkol 2021; 198:484-496. [PMID: 34888732 PMCID: PMC9038902 DOI: 10.1007/s00066-021-01872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
Purpose In stereotactic radiosurgery (SRS), prescription isodoses and resulting dose homogeneities vary widely across different platforms and clinical entities. Our goal was to investigate the physical limitations of generating dose distributions with an intended level of homogeneity in robotic SRS. Methods Treatment plans for non-isocentric irradiation of 4 spherical phantom targets (volume 0.27–7.70 ml) and 4 clinical targets (volume 0.50–5.70 ml) were calculated using Sequential (phantom) or VOLOTM (clinical) optimizers (Accuray, Sunnyvale, CA, USA). Dose conformity, volume of 12 Gy isodose (V12Gy) as a measure for dose gradient, and treatment time were recorded for different prescribed isodose levels (PILs) and collimator settings. In addition, isocentric irradiation of phantom targets was examined, with dose homogeneity modified by using different collimator sizes. Results Dose conformity was generally high (nCI ≤ 1.25) and varied little with PIL. For all targets and collimator sets, V12Gy was highest for PIL ≥ 80% and lowest for PIL ≤ 65%. The impact of PIL on V12Gy was highest for isocentric irradiation and lowest for clinical targets (VOLOTM optimization). The variability of V12Gy as a function of collimator selection was significantly higher than that of PIL. V12Gy and treatment time were negatively correlated. Plans utilizing a single collimator with a diameter in the range of 70–80% of the target diameter were fastest, but showed the strongest dependence on PIL. Conclusion Inhomogeneous dose distributions with PIL ≤ 70% can be used to minimize dose to normal tissue. PIL ≥ 90% is associated with a marked and significant increase in off-target dose exposure. Careful selection of collimators during planning is even more important. Supplementary Information The online version of this article (10.1007/s00066-021-01872-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexandra Hellerbach
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Markus Eichner
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Daniel Rueß
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Klaus Luyken
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Mauritius Hoevels
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Michael Judge
- Faculty of Medicine and University Hospital Cologne, Institute of Radiation Oncology, University of Cologne, Cologne, Germany
| | - Christian Baues
- Faculty of Medicine and University Hospital Cologne, Institute of Radiation Oncology, University of Cologne, Cologne, Germany
| | - Maximilian Ruge
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Martin Kocher
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Harald Treuer
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Verification of an optimizer algorithm by the beam delivery evaluation of intensity-modulated arc therapy plans. Radiol Oncol 2021; 55:508-515. [PMID: 34821138 PMCID: PMC8647790 DOI: 10.2478/raon-2021-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background In the case of dynamic radiotherapy plans, the fractionation schemes can have dosimetric effects. Our goal was to define the effect of the fraction dose on the plan quality and the beam delivery. Materials and methods Treatment plans were created for 5 early-stage lung cancer patients with different dose schedules. The planned total dose was 60 Gy, fraction dose was 2 Gy, 3 Gy, 5 Gy, 12 Gy and 20 Gy. Additionally renormalized plans were created by changing the prescribed fraction dose after optimization. The dosimetric parameters and the beam delivery parameters were collected to define the plan quality and the complexity of the treatment plans. The accuracy of dose delivery was verified with dose measurements using electronic portal imaging device (EPID). Results The plan quality was independent from the used fractionation scheme. The fraction dose could be changed safely after the optimization, the delivery accuracy of the treatment plans with changed prescribed dose was not lower. According to EPID based measurements, the high fraction dose and dose rate caused the saturation of the detector, which lowered the gamma passing rate. The aperture complexity score, the gantry speed and the dose rate changes were not predicting factors for the gamma passing rate values. Conclusions The plan quality and the delivery accuracy are independent from the fraction dose, moreover the fraction dose can be changed safely after the dose optimization. The saturation effect of the EPID has to be considered when the action limits of the quality assurance system are defined.
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Masuda H, Kawahara D, Saito A, Kimura T, Ozawa S, Nakashima T, Nagata Y. Reduction of margin to compensate the respiratory tumor motion by the analysis of dosimetric internal target volume in lung SBRT with nonuniform volume prescription method. Med Phys 2021; 48:3200-3207. [PMID: 33792065 DOI: 10.1002/mp.14871] [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: 09/07/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To develop a dosimetric internal target volume (ITV) margin (DIM) for respiratory motion in lung stereotactic body radiotherapy (SBRT) and to evaluate DIM with a nonuniform volume prescription (NVP) and the point prescription (PP). METHODS Volumetric modulated arc therapy (VMAT) treatment plans with PP and NVP were created on a heterogeneous programmable respiratory motion phantom, with a tumor (30-mm diameter) inside a cylindrical lung insert. The tumor was defined as the gross tumor volume (GTV), equal to the clinical target volume (CTV). Five-millimeter and 0-mm margins were used for the ITV and setup margins, respectively. The phantom was moved in cranio-caudal direction with a biquadratic sinusoidal waveform with a 4-s cycle and an amplitude of ±5-10 mm. The interplay effect was evaluated by measuring the dose profile with a film in the sagittal plane for different respiratory periods and different initial respiratory phases. DIM was based on the respiratory motion amplitude that satisfied 100% and 95% coverage of the prescribed dose by the minimum dose of the CTV. Moreover, the absolute dose was measured with and without respiratory motion for NVP by a pinpoint chamber. RESULTS The dose difference in the tumor region due to the interplay effect was within 1.0%. The gamma passing rate was over 95.1% for different respiratory periods and 98.6% for different initial respiratory phases. DIM with PP was almost equivalent to the margin of the respiratory motion. However, DIM with NVP was 2.0 and 1.8 times larger than the margin of the respiratory motion for the 100% and 95% coverage of the prescribed doses, respectively. CONCLUSION The interplay effects experienced between the MLC sequence and tumor motion were negligible for NVP. The DIM analysis revealed that the margin to compensate the respiratory tumor motion could be reduced by more than 44-50% for NVP in SBRT.
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Affiliation(s)
- Hirokazu Masuda
- Radiation Therapy Section, Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Hiroshima, 734-8551, Japan
| | - Daisuke Kawahara
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan
| | - Akito Saito
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shuichi Ozawa
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, 732-0057, Japan
| | - Takeo Nakashima
- Radiation Therapy Section, Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Hiroshima, 734-8551, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, 732-0057, Japan
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Desai D, Narayanasamy G, Bimali M, Cordrey I, Elasmar H, Srinivasan S, Johnson EL. Cleaning the dose falloff in lung SBRT plan. J Appl Clin Med Phys 2020; 22:100-108. [PMID: 33285036 PMCID: PMC7856511 DOI: 10.1002/acm2.13113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/07/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate a planning technique that can possibly reduce low-to-intermediate dose spillage (measured by R50%, D2cm values) in lung SBRT plans. MATERIALS AND METHODS Dose falloff outside the target was studied retrospectively in 102 SBRT VMAT plans of lung tumor. Plans having R50% and/or D2cm higher than recommended tolerances in RTOG protocols 0813 and 0915 were replanned with new optimization constraints using novel shell structures and novel constraints. Violations in the RTOG R50% value can be rectified with a dose constraint to a novel shell structure ("OptiForR50"). The construction of structure OptiForR50% and the novel optimization criteria translate the RTOG goals for R50% into direct inputs for the optimizer. Violations in the D2cm can be rectified using constraints on a 0.5 cm thick shell structure with inner surface 2cm from the PTV surface. Wilcoxon signed-rank test was used to compare differences in dose conformity, volume of hot spots, R50%, D2cm of the target in addition to the OAR doses. A two-sided P-value of 0.05 was used to assess statistical significance. RESULTS Among 102 lung SBRT plans with PTV sizes ranging from 5 to 179 cc, 32 plans with violations in R50% or D2cm were reoptimized. The mean reduction in R50% (4.68 vs 3.89) and D2cm (56.49 vs 52.51) was statistically significant both having P < 0.01. Target conformity index, volume of 105% isodose contour outside PTV, normal lung V20, and mean dose to heart and aorta were significantly lowered with P < 0.05. CONCLUSION The novel planning methodology using multiple shells including the novel OptiForR50 shell with precisely calculated dimensions and optimizer constraints lead to significantly lower values of R50% and D2cm and lower dose spillage in lung SBRT plans. All plans were successfully brought into the zone of no RTOG violations.
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Affiliation(s)
| | - Ganesh Narayanasamy
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Milan Bimali
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | - Ellis Lee Johnson
- Department of Radiation Medicine, University of Kentucky, Lexington, KY, USA
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Desai DD, Cordrey IL, Johnson EL. A physically meaningful relationship between R50% and PTV surface area in lung SBRT. J Appl Clin Med Phys 2020; 21:47-56. [PMID: 32725674 PMCID: PMC7497922 DOI: 10.1002/acm2.12964] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose We propose a novel understanding of two characteristics of the planning target volume (PTV) that affect the intermediate‐dose spill in lung stereotactic body radiation therapy (SBRT) as measured by R50%. This phantom model research investigates two characteristics of the PTV that have a marked effect on the value of R50%: the mean dose deposited within the PTV (Dav) and the surface area of the PTV (SAPTV). Methods Using a phantom model provided by a CT of the IROC Thorax‐Lung Phantom® (IROC Houston QA Center, Houston, TX) and Eclipse® Treatment Planning System (Varian Medical Systems, Palo Alto, CA), we investigate the two characteristics for spherical and cylindrical PTVs. A total of 135 plans with tightly controlled PTV characteristics are employed. A lower bound for R50% (R50%min∆r) is derived and clearly establishes a relationship between R50% and SAPTV that has not been fully appreciated previously. Results The study of PTV Dav revealed a local minimum for R50% as a function of the PTV Dav at Dav ≈ 110% of Rx dose. As PTV Dav increases above this local minimum, R50% increases; while for PTV Dav less than this local minimum, the R50% value also increases. The study of PTV surface area (SAPTV) demonstrated that as the SAPTV increases, the R50% increases if the PTV volume stays the same. The SAPTV result is predicted by the theoretical investigation that yields the R50% lower bound, R50%min∆r. Conclusions This research has identified two characteristics of the PTV that have a marked influence on R50%: PTV Dav and SAPTV. These characteristics have not been clearly articulated in the vast body of previous research in SBRT. These results could help explain plans that cannot meet the RTOG criteria for R50%. With further development, these concepts could be extended to provide additional guidance for creating acceptable SBRT plans.
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Affiliation(s)
- Dharmin D Desai
- Radiation Oncology, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Ivan L Cordrey
- Radiation Oncology, CHI Memorial Hospital, Chattanooga, TN, USA
| | - E L Johnson
- Department of Radiation Medicine, University of Kentucky Chandler Medical Center, Lexington, KY, USA
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Marrazzo L, Arilli C, Pellegrini R, Bonomo P, Calusi S, Talamonti C, Casati M, Compagnucci A, Livi L, Pallotta S. Automated planning through robust templates and multicriterial optimization for lung VMAT SBRT of lung lesions. J Appl Clin Med Phys 2020; 21:114-120. [PMID: 32275353 PMCID: PMC7324702 DOI: 10.1002/acm2.12872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To develop and validate a robust template for VMAT SBRT of lung lesions, using the multicriterial optimization (MCO) of a commercial treatment planning system. Methods The template was established and refined on 10 lung SBRT patients planned for 55 Gy/5 fr. To improve gradient and conformity a ring structure around the planning target volume (PTV) was set in the list of objectives. Ideal fluence optimization was conducted giving priority to organs at risk (OARs) and using the MCO, which further pushes OARs doses. Segmentation was conducted giving priority to PTV coverage. Two different templates were produced with different degrees of modulation, by setting the Fluence Smoothing parameter to Medium (MFS) and High (HFS). Each template was applied on 20 further patients. Automatic and manual plans were compared in terms of dosimetric parameters, delivery time, and complexity. Statistical significance of differences was evaluated using paired two‐sided Wilcoxon signed‐rank test. Results No statistically significant differences in PTV coverage and maximum dose were observed, while an improvement was observed in gradient and conformity. A general improvement in dose to OARs was seen, which resulted to be significant for chest wall V30 Gy, total lung V20 Gy, and spinal cord D0.1 cc. MFS plans are characterized by a higher modulation and longer delivery time than manual plans. HFS plans have a modulation and a delivery time comparable to manual plans, but still present an advantage in terms of gradient. Conclusion The automation of the planning process for lung SBRT using robust templates and MCO was demonstrated to be feasible and more efficient.
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Affiliation(s)
- Livia Marrazzo
- Careggi University Hospital, Medical Physic Unit, Florence, Italy
| | - Chiara Arilli
- Careggi University Hospital, Medical Physic Unit, Florence, Italy
| | | | | | - Silvia Calusi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Cinzia Talamonti
- Careggi University Hospital, Medical Physic Unit, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Marta Casati
- Careggi University Hospital, Medical Physic Unit, Florence, Italy
| | | | - Lorenzo Livi
- Careggi University Hospital, Radiotherapy Unit, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Stefania Pallotta
- Careggi University Hospital, Medical Physic Unit, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Massaccesi M, Boldrini L, Piras A, Stimato G, Quaranta F, Azario L, Mattiucci GC, Valentini V. Spatially fractionated radiotherapy (SFRT) targeting the hypoxic tumor segment for the intentional induction of non-targeted effects: An in silico study to exploit a new treatment paradigm. Tech Innov Patient Support Radiat Oncol 2020; 14:11-14. [PMID: 32154394 PMCID: PMC7052565 DOI: 10.1016/j.tipsro.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The possibility of intentionally triggering non targeted effects (NTEs) using spatially fractionated radiotherapy (SFRT) alone or combined with immunotherapy is an intriguing and fascinating area of research. Among different techniques for SFRT, stereotactic body radiotherapy targeting exclusively the central hypoxic segment of bulky tumors, (SBRT-PATHY) might trigger immunogenic cell death more efficiently. This in silico study aims to identify the best possible dosimetric trade-off for prescribing SFRT with volumetric modulated arc (VMAT) based stereotactic radiotherapy (SRT). Material and methods Eight spherical volumes defined "Gross Tumor Volumes" (GTVs) were generated with diameters of 3-10 cm (with incremental steps of 1 cm), simulating tumor lesions. The inner third part of each GTV (GTVcentral) was selected to simulate the central hypoxic area and a ring structure was derived around it to simulate the tumor periphery (GTVperipheral). Volumetric modulated arc radiation treatment (VMAT) plans were calculated to deliver a single fraction of 10 Gy to each GTVcentral with different dose prescription methods: target mean and isodose driven (40, 50, 60, 70, 80 and 90%).The volume of GTVperipheral receiving less than 2 Gy was recorded as dosimetric performance indicator. Results 56 possible dosimetric scenarios were analyzed. The largest percentage of GTVperipheral spared from the dose of 2 Gy was achieved with dose prescription methods to the 70% isodose line for lesions smaller than 6 cm (range 42.9-48.4%) and to the target mean for larger ones (range 52.9-64.5%). Conclusions Optimizing the dose prescription method may reduce the dose to tumor periphery in VMAT-based SFRT, thus potentially sparing tumor infiltrating immune cells. The optimal method may vary according to the size of the lesion. This should be taken into account when designing prospective trials using SFRT.
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Affiliation(s)
- M Massaccesi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - L Boldrini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - A Piras
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - G Stimato
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Fisica Sanitaria, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - F Quaranta
- Università Cattolica del Sacro Cuore, Istituto di Fisica, Roma, Italy
| | - L Azario
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Fisica Sanitaria, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.,Università Cattolica del Sacro Cuore, Istituto di Fisica, Roma, Italy
| | - G C Mattiucci
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.,Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - V Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.,Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
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12
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Wang D, DeNittis A, Evans T, Meyer T. Optimal prescription isodose line in SBRT for lung tumor treatment with volumetric-modulated arc therapy. JOURNAL OF RADIOSURGERY AND SBRT 2020; 7:157-164. [PMID: 33282469 PMCID: PMC7717096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/27/2020] [Indexed: 06/12/2023]
Abstract
It is crucial to spare lung when treating early stage lung carcinoma with stereotactic body radiotherapy (SBRT) for minimizing the radiation induced toxicities, such as radiation pneumonitis and late fibrosis. A retrospective study was performed with a combination of approaches to determine the optimal range of prescription isodose line (P-IDL) within which lung tissue was best spared in SBRT plans with Volumetric-Modulated Arc Therapy (VMAT) and Monte-Carlo-like dose calculation algorithm. Twenty clinically-delivered SBRT lung plans were optimized using traditional LINAC MLC based approaches: an average P-IDL of (88.8 ± 0.5)% (the error bar of all the data is the 95% confidence interval (CI)). The plans were then re-optimized using a new combination of approaches with variation of P-IDL from 60% to 90% for each case. The combination of approaches included finding and utilizing an optimal P-IDL, implementing tuning ring structures internal and external to the target, as well as normal tissue objective and equivalent. The plans were evaluated with the following indexes: 1. R50%, the ratio of 50% prescription isodose volume to the plan target volume (PTV); 2. V20 and V5, the volume of lung within 20Gy and 5Gy, respectively; 3. PCI, the Paddick comformity index; 4. D2cm, the maximum dose at 2 cm from PTV in any direction; 5. MLD, the mean dose in total lung volume; 6. Focal Index (FI), an indicator of dose in the core of the target. The optimal P-IDL was found to be in the range of 75-80%. The average optimal P-IDL for the 20 cases was (77.9 ± 0.9)%. With the optimization strategies the average PCI was increased by (10.3 ± 2.1)%; the average R50%, V20, V5, D2cm and MLD were decreased by (29.1 ± 4.1)%, (26.9 ± 5.4)%, (13.9 ± 3.5)%, (13.4 ± 4.3)% and (16.7 ± 2.3)%, respectively. The FI was increased by (23.7 ± 1.3)%. The optimal P-IDL range was 75-80% for SBRT VMAT lung treatment plans. The application of the set of optimization approaches can significantly improve the lung sparing in SBRT VMAT plans with AXB dose calculation algorithm and makes treatment plans more conformal in high, intermediate and low dose regions, while higher dose is delivered to the target.
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Affiliation(s)
- David Wang
- Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
| | - Albert DeNittis
- Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
- Lankenau Institute for Medical Research, 100 East Lancaster Avenue, Wynnewood, PA 19096, USA
| | - Tracey Evans
- Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
| | - Thomas Meyer
- Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
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Xu Y, Ma P, Xu Y, Dai J. Selection of prescription isodose line for brain metastases treated with volumetric modulated arc radiotherapy. J Appl Clin Med Phys 2019; 20:63-69. [PMID: 31833642 PMCID: PMC6909111 DOI: 10.1002/acm2.12761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/26/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To exploit the optimal prescription isodose line (IDL) for brain metastases treated with volumetric modulated arc radiotherapy (VMAT) as there is no consensus on the selection of IDL with VMAT. Methods and materials Eighteen patients with 20 brain tumors, who were treated with VMAT, were enrolled in this study. For each tumor of every patient, five plans were designed with IDL ranging from 50% to 90% in 10% increments. Different IDLs were obtained through adjusting the constraint parameters during planning optimization. Prescription dose (10 × 5 Gy) were identical for all plans, and the plans were compared in terms of gradient index (GI), conformity Index (CI), V26 Gy/VPTV, and V32 Gy/VPTV in normal brain tissue, which correlate to radiation necrosis. Results IDL with lowest GI has a median value of 60.0% (ranging from 50% to 80%). Except for one tumor with volume larger than 10 cc, the IDL with lowest GI varies from 50% to 70%, which depends on the shape of PTV, location, and whether the target volume is adjacent to crucial OAR. Moreover, there is no significant difference for CI with varying IDL plans. The average V26 Gy/VPTV and V32 Gy/VPTV in normal brain tissue 60% IDL plans are 27.3%, 31.7% lower than 90% IDL plans separately (P < 0.05). However, by further decreasing IDL from 60% to 50%, the average V26 Gy/VPTV and V32 Gy/VPTV may increase comparing with 60% IDL plans (P > 0.05). Furthermore, a lower IDL is found to result in higher mean dose to the target volume (P < 0.05). Conclusions Plans using VMAT with PTV smaller than 10 cc tend to be optimal with IDL around 60–70% for lower GI, smaller V26 Gy/VPTV, V32 Gy/VPTV in normal brain tissue, and higher mean dose in tumor comparing with high IDL plans which have potential benefit in reducing risk of radiation necrosis and increasing the local control. However, IDL lower than 60% is not recommended for the disadvantage of increasing V26 Gy/VPTV and V32 Gy/VPTV in normal brain tissue.
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Affiliation(s)
- Yuan Xu
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Pan Ma
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yingjie Xu
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jianrong Dai
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Dosimetric Multicenter Planning Comparison Studies for Stereotactic Body Radiation Therapy: Methodology and Future Perspectives. Int J Radiat Oncol Biol Phys 2019; 106:403-412. [PMID: 31707124 DOI: 10.1016/j.ijrobp.2019.10.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/03/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
In this review a summary of the published literature pertaining to the stereotactic body radiation therapy multiplanning comparison, data sharing strategies, and implementation of benchmark planning cases to improve the skills and knowledge of the participating centers was investigated. A total of 30 full-text articles were included. The studies were subdivided in 3 categories: multiplanning studies on dosimetric variability, planning harmonization before clinical trials, and technical and methodologic studies. The methodology used in the studies were critically analyzed to find common and original elements with the pros and cons. Multicenter planning studies have played a key role in improving treatment plan harmonization, treatment plan compliance, and even clinical practices. This review has highlighted that some fundamental steps should be taken to transform a simple treatment planning comparison study into a potential credentialing method for stereotactic body radiation therapy accreditation. In particular, prescription and general requirements should always be well defined; data analysis should be performed with independent dose volume histogram or dose calculations; quality score indices should be constructed; feedback and correction strategies should be provided; and a simple web-based collaboration platform should be used. The results reported clearly showed that a crowd-based replanning approach is a viable method for achieving harmonization and standardization of treatment planning among centers using different technologies.
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Chan MKH, Lee VWY, Kadoya N, Chiang CL, Wong MYP, Leung RWK, Cheung S, Blanck O. Single fraction computed tomography-guided high-dose-rate brachytherapy or stereotactic body radiotherapy for primary and metastatic lung tumors? J Contemp Brachytherapy 2018; 10:446-453. [PMID: 30479622 PMCID: PMC6251454 DOI: 10.5114/jcb.2018.79335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 09/27/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To provide a pilot dosimetric study of computed tomography (CT)-guided high-dose-rate (HDR) brachytherapy (BRT) and stereotactic body radiotherapy (SBRT) for primary and metastatic lung lesions. MATERIAL AND METHODS For nine lung primary and metastasis patients, 3D image-based BRT plan using a single virtual catheter was planned for 34 Gy in single fraction to the gross tumor volume (GTV) + 3 mm margin to account for tumor deformation. These plans were compared to margin-based (MB-) and robustness optimized (RO-) SBRT, assuming the same tumor deformation under real-time tumor tracking. Consistent dose calculation was ensured for both BRT and SBRT plans using the same class of collapsed cone convolution superposition algorithm. Plan quality metrics were compared by Friedman tests and Wilcoxon t-tests. RESULTS AND CONCLUSIONS Brachytherapy plans showed significant higher GTV mean dose compared to MB- and RO-SBRT (122.2 Gy vs. 50.4 and 44.7 Gy, p < 0.05), and better dose gradient index (R50) = 2.9 vs. 4.3 and 8.4 for MB- and RO-SBRT, respectively. Dose constraints per the RTOG 0915 protocol were achieved for all critical organs except chest wall in BRT. All other dose-volume histograms (DVH) metrics are comparable between BRT and SBRT. Treatment delivery time of BRT and SBRT plans significantly increased and decreased with increasing GTV size, respectively. SBRT using advanced MLC tracking technique and non-coplanar VMAT can achieve comparable dosimetric quality to HDR BRT. Whether or not, the significantly higher GTV dose can increase killing of radioresistant tumor cells and offset the effect of tumor reoxygenation in single fraction BRT, requires further clinical investigation.
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Affiliation(s)
- Mark KH Chan
- Department of Radiation Oncology, University Schleswig-Holstein, Kiel Campus, Germany
| | - Venus WY Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan
| | - Chi-Leung Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Hong Kong (S.A.R)
| | - Matthew YP Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
| | - Ronnie WK Leung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
| | - Steven Cheung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (S.A.R)
| | - Oliver Blanck
- Department of Radiation Oncology, University Schleswig-Holstein, Kiel Campus, Germany
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Barillot I, Antoni D, Bellec J, Biau J, Giraud P, Jenny C, Lacornerie T, Lisbona A, Marchesi V, Mornex F, Supiot S, Thureau S, Noel G. Bases référentielles de la radiothérapie en conditions stéréotaxiques pour les tumeurs ou métastases bronchopulmonaires, hépatiques, prostatiques, des voies aérodigestives supérieures, cérébrales et osseuses. Cancer Radiother 2018; 22:660-681. [DOI: 10.1016/j.canrad.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
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Wang Y, Chen L, Zhu F, Guo W, Zhang D, Sun W. A study of minimum segment width parameter on VMAT plan quality, delivery accuracy, and efficiency for cervical cancer using Monaco TPS. J Appl Clin Med Phys 2018; 19:609-615. [PMID: 30058257 PMCID: PMC6123131 DOI: 10.1002/acm2.12422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 11/15/2022] Open
Abstract
Purpose The purpose of this study was to study the influence of the minimum segment width (MSW) on volumetric modulated arc therapy (VMAT) plan quality, delivery accuracy, and efficiency for cervical cancer treatment. Methods Nineteen patients with cervical cancer were randomly selected to design VMAT plans. Three VMAT plans were generated for each patient incorporating MSWs of 0.5, 1.0, and 1.5 cm while other planning parameters remained constant using the Monaco treatment planning system (TPS) with 6 MV X rays delivered from an Elekta Synergy linear accelerator. Plan quality and delivery efficiency were evaluated based on dose‐volume histograms (DVHs), control points, monitor units (MUs), dosimetric measurement verification results, and plan delivery time. Results Except for the small difference in target dose coverage and maximum dose, there were no statistically significant differences between the other dosimetric parameters in the planning target volumes. The 1.0 and 1.5 cm MSW plans showed lower maximum doses to the spinal cord than the 0.5 cm plan; doses to other organs at risks were similar regardless of MSWs. The mean reductions of total MUs when compared with the 0.5 cm plan were 14.5 ± 6.1% and 20.9 ± 7.9% for MSWs of 1.0 and 1.5 cm, respectively. The calculated gamma indices using the 3% and 3 mm criteria were 96.2 ± 0.6%, 97.0 ± 0.6%, and 97.6 ± 0.6% for the 0.5, 1.0 and 1.5 cm MSW plans, respectively. The plan delivery times decreased with increasing MSWs (p < 0.05). Conclusion Increasing the MSW allows for improved plan delivery accuracy and efficiency without significantly affecting the VMAT plan quality. MSWs of 1.0 and 1.5 cm improved the plan quality, delivery accuracy, and efficiency for cervical VMAT radiation therapy.
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Affiliation(s)
- Yuanyuan Wang
- Department of Radiation Oncology, Hefei Ion Medical Center, Hefei, China
| | - Li Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fengying Zhu
- Shunde Hospital of Southern Medical University, Shunde, China
| | | | - Dandan Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wenzhao Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Fleckenstein J, Boda-Heggemann J, Siebenlist K, Gudzheva T, Prakofyeva N, Lohr F, Wenz F, Simeonova-Chergou A. Non-coplanar VMAT combined with non-uniform dose prescription markedly reduces lung dose in breath-hold lung SBRT. Strahlenther Onkol 2018; 194:815-823. [PMID: 29802434 DOI: 10.1007/s00066-018-1316-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE In this retrospective treatment planning study, the effect of a uniform and non-uniform planning target volume (PTV) dose coverage as well as a coplanar and non-coplanar volumetric modulated arc therapy (VMAT) delivery approach for lung stereotactic body radiation therapy (SBRT) in deep inspiration breath-hold (DIBH) were compared. MATERIALS AND METHODS For 46 patients with lesions in the peripheral lungs, three different treatment plans were generated: First, a coplanar 220° VMAT sequence with a uniform PTV dose prescription (UC). Second, a coplanar 220° VMAT treatment plan with a non-uniform dose distribution in the PTV (nUC). Third, a non-coplanar VMAT dose delivery with four couch angles (0°, ±35°, 90°) and a non-uniform prescription (nUnC) was used. All treatment plans were optimized for pareto-optimality with respect to PTV coverage and ipsilateral lung dose. Treatment sequences were delivered on a flattening-filter-free linear accelerator and beam-on times were recorded. Dosimetric comparison between the three techniques was performed. RESULTS For the three scenarios (UC, nUC, nUnC), median gross tumor volume (GTV) doses were 63.4 ± 2.5, 74.4 ± 3.6, and 77.9 ± 3.8 Gy, and ipsilateral V10Gy lung volumes were 15.7 ± 6.1, 13.9 ± 4.7, and 12.0 ± 5.1%, respectively. Normal tissue complication probability of the ipsilateral lung was 3.9, 3.1, and 2.8%, respectively. The number of monitor units were 5141 ± 1174, 4104 ± 786, and 3657 ± 710 MU and the corresponding beam-on times were 177 ± 54, 143 ± 29, and 148 ± 26 s. CONCLUSION For SBRT treatments in DIBH, a non-uniform dose prescription in the PTV, combined with a non-coplanar VMAT arc arrangement, significantly spares the ipsilateral lung while increasing dose to the GTV without major treatment time increase.
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Affiliation(s)
- Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kerstin Siebenlist
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tanya Gudzheva
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Natallia Prakofyeva
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Lohr
- Unita Operativa di Radioterapia, Department of Oncology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Anna Simeonova-Chergou
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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