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Mann T, Ploquin N, Faruqi S, Loewen S, Thind K. Stereotactic Optimized Automated Radiotherapy (SOAR): a novel automated planning solution for multi-metastatic SRS compared to HyperArc™. Biomed Phys Eng Express 2024; 10:025037. [PMID: 38364285 DOI: 10.1088/2057-1976/ad2a1b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/16/2024] [Indexed: 02/18/2024]
Abstract
Objective.Automated Stereotactic Radiosurgery (SRS) planning solutions improve clinical efficiency and reduce treatment plan variability. Available commercial solutions employ a template-based strategy that may not be optimal for all SRS patients. This study compares a novel beam angle optimized Volumetric Modulated Arc Therapy (VMAT) planning solution for multi-metastatic SRS to the commercial solution HyperArc.Approach.Stereotactic Optimized Automated Radiotherapy (SOAR) performs automated plan creation by combining collision prediction, beam angle optimization, and dose optimization to produce individualized high-quality SRS plans using Eclipse Scripting. In this retrospective study 50 patients were planned using SOAR and HyperArc. Assessed dose metrics included the Conformity Index (CI), Gradient Index (GI), and doses to organs-at-risk. Complexity metrics evaluated the modulation, gantry speed, and dose rate complexity. Plan dosimetric quality, and complexity were compared using double-sided Wilcoxon signed rank tests (α= 0.05) adjusted for multiple comparisons.Main Results.The median target CI was 0.82 with SOAR and 0.79 with HyperArc (p < .001). Median GI was 1.85 for SOAR and 1.68 for HyperArc (p < .001). The median V12Gy normal brain volume for SOAR and HyperArc were 7.76 cm3and 7.47 cm3respectively. Median doses to the eyes, lens, optic nerves, and optic chiasm were statistically significant favoring SOAR. The SOAR algorithm scored lower for all complexity metrics assessed.Significance.In-house developed automated planning solutions are a viable alternative to commercial solutions. SOAR designs high-quality patient-specific SRS plans with a greater degree of versatility than template-based methods.
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Affiliation(s)
- Thomas Mann
- Department of Physics and Astronomy, University of Calgary, AB, Canada
- Division of Medical Physics, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, AB, Canada
| | - Nicolas Ploquin
- Department of Physics and Astronomy, University of Calgary, AB, Canada
- Division of Medical Physics, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, AB, Canada
| | - Salman Faruqi
- Division of Radiation Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Alberta, Canada
| | - Shaun Loewen
- Division of Radiation Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Alberta, Canada
| | - Kundan Thind
- Division of Medical Physics, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, AB, Canada
- Department of Medical Physics, Henry Ford Health Systems, Detroit, MI, United States of America
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Jung H, Yoon J, Dona Lemus O, Tanny S, Zhou Y, Milano M, Usuki K, Hardy S, Zheng D. Dosimetric evaluation of LINAC-based single-isocenter multi-target multi-fraction stereotactic radiosurgery with more than 20 targets: comparing MME, HyperArc, and RapidArc. Radiat Oncol 2024; 19:19. [PMID: 38326813 PMCID: PMC10848506 DOI: 10.1186/s13014-024-02416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND To compare the dosimetric quality of three widely used techniques for LINAC-based single-isocenter multi-target multi-fraction stereotactic radiosurgery (fSRS) with more than 20 targets: dynamic conformal arc (DCA) in BrainLAB Multiple Metastases Elements (MME) module and volumetric modulated arc therapy (VMAT) using RapidArc (RA) and HyperArc (HA) in Varian Eclipse. METHODS Ten patients who received single-isocenter fSRS with 20-37 targets were retrospectively replanned using MME, RA, and HA. Various dosimetric parameters, such as conformity index (CI), Paddick CI, gradient index (GI), normal brain dose exposures, maximum organ-at-risk (OAR) doses, and beam-on times were extracted and compared among the three techniques. Wilcoxon signed-rank test was used for statistical analysis. RESULTS All plans achieved the prescribed dose coverage goal of at least 95% of the planning target volume (PTV). HA plans showed superior conformity compared to RA and MME plans. MME plans showed superior GI compared to RA and HA plans. RA plans resulted in significantly higher low and intermediate dose exposure to normal brain compared to HA and MME plans, especially for lower doses of ≥ 8Gy and ≥ 5Gy. No significant differences were observed in the maximum dose to OARs among the three techniques. The beam-on time of MME plans was about two times longer than RA and HA plans. CONCLUSIONS HA plans achieved the best conformity, while MME plans achieved the best dose fall-off for LINAC-based single-isocenter multi-target multi-fraction SRS with more than 20 targets. The choice of the optimal technique should consider the trade-offs between dosimetric quality, beam-on time, and planning effort.
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Affiliation(s)
- Hyunuk Jung
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA.
| | - Jihyung Yoon
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Olga Dona Lemus
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Sean Tanny
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Yuwei Zhou
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Michael Milano
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Kenneth Usuki
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Sara Hardy
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Dandan Zheng
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
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Cavalli N, Bonanno E, Borzì GR, D'Anna A, Pace M, Stella G, Zirone L, Marino C. Is it still necessary to perform measured based pre-treatment patient-specific QA for SRS HyperArc treatments? J Appl Clin Med Phys 2024; 25:e14156. [PMID: 37803884 PMCID: PMC10860540 DOI: 10.1002/acm2.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/04/2023] [Accepted: 08/22/2023] [Indexed: 10/08/2023] Open
Abstract
PURPOSE The Mobius3D system was validated as a modern secondary check dosimetry system. In particular, our objective has been to assess the suitability of the M3D as pre-treatment patient-specific Quality Assurance (QA) tool for Stereotactic Radiosurgery (SRS) HyperArc (HA) treatments. We aimed to determine whether Mobius3D could safely replace the measurements-based patient-specific QA for this type of treatment. METHODS 30 SRS HA treatment plans for brain were selected. The dose distributions, calculated by Mobius and our routinely used algorithm (AcurosXB v.15.6), were compared using gamma analysis index and DVH parameters based on the patient's CT dataset. All 30 plans were then delivered across the ionization chamber in a homogeneous phantom and the measured dose was compared with both M3D and TPS calculated one. The plans were delivered and verified in terms of PSQA using the electronic portal imaging device (EPID) with Portal Dosimetry (PD) and myQA SRS (IBA Dosimetry) detector. Plans that achieved a global gamma passing rate (GPR) ≥ 97% based on 2%/2 mm criteria, with both Mobius3D and the conventional methods were evaluated acceptable. Finally, we assessed the capability of the M3D system to detect errors related to the position of the Multi-Leaf Collimator (MLC) in comparison to the analyzed measurement-based systems. RESULTS No relevant differences were observed in the comparison between the dose calculated on the CT-dataset by M3D and the TPS. Observed discrepancies are imputable to different used algorithms, but no discrepancies related to goodness of plans have been found. Average differences between calculated (M3D and TPS) vs measured dose with ionization chamber were 2.5% (from 0.41% to 3.2%) and 1.81% (from 0.66% to 2.65%), for M3D and TPS, respectively. All plans passed with a gamma passing rate > 97% using conventional PSQA methods with a gamma criterion of 2% dose difference and 2 mm distance-to-agreement. The average gamma passing rate for the M3D system was determined to be 99.4% (from 97.3% to 100%). Results from this study also demonstrated Mobius has better error detectability than conventional measurement-based systems. CONCLUSION Our study shows Mobius3D could be a suitable alternative to conventional measured based QA methods for SRS HyperArc treatments.
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Affiliation(s)
- Nina Cavalli
- Medical Physics DepartmentHumanitas Istituto Clinico CataneseMisterbiancoCTItaly
| | - Elisa Bonanno
- Medical Physics DepartmentHumanitas Istituto Clinico CataneseMisterbiancoCTItaly
| | - Giuseppina R. Borzì
- Medical Physics DepartmentHumanitas Istituto Clinico CataneseMisterbiancoCTItaly
| | - Alessia D'Anna
- Physics and Astronomy Department E. MajoranaUniversity of CataniaCataniaItaly
| | - Martina Pace
- Medical Physics DepartmentHumanitas Istituto Clinico CataneseMisterbiancoCTItaly
| | - Giuseppe Stella
- Physics and Astronomy Department E. MajoranaUniversity of CataniaCataniaItaly
| | - Lucia Zirone
- Medical Physics DepartmentHumanitas Istituto Clinico CataneseMisterbiancoCTItaly
| | - Carmelo Marino
- Medical Physics DepartmentHumanitas Istituto Clinico CataneseMisterbiancoCTItaly
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Li F, Mail N, Stefania diMayorca M, McCaw TJ, Ozhasoglu C, Lalonde R, Chang J, Huq MS. Single isocenter HyperArc treatment of multiple intracranial metastases: Targeting accuracy. J Appl Clin Med Phys 2024; 25:e14234. [PMID: 38059673 PMCID: PMC10795440 DOI: 10.1002/acm2.14234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE/OBJECTIVES (A) To examine the alignment accuracy of CBCT guidance for brain metastases with off centered isocenters, (B) to test dose delivery and targeting accuracy for single isocenter treatments with multiple brain metastases. We report the results of the end-to-end test for Truebeam stereotactic radiosurgery (SRS). MATERIALS/METHODS An anthropomorphic CT head phantom was drilled with five MOSFET inserts and two PTW Pinpoint chamber inserts. The phantom was simulated, planned, and delivered. For the purpose of comparing the accuracy of alignment, CBCTs were acquired with the isocenter centered and offset superiorly 8 cm, inferiorly 8 cm, anteriorly 7 cm, posteriorly 7 cm, and right 5 cm. There were six degrees of freedom corrections applied to the plans, as well as intentional rotational and translational errors for dose comparisons. Dose accuracy checks were performed with MOSFET and PTW Pinpoint chamber, and targeting accuracy was assessed with GafChromic films. RESULT (A) Compared to centered CBCT, off-centered CBCT scan showed some alignment errors, with a maximum difference of 0.6-degree pitch and 0.9 mm translation when the phantom was placed 8 cm inferior off center. (B) For the single isocenter plan, measured doses of the five MOSFET were 95%-100% of the planned dose, whereas the multiple isocenter plans were 96%-100%. With intentional setup errors of 1-degree pitch, doses were 97.1%-100.4% compared to the perfect setup. The same was found for the two pinpoint chamber readings with 1-degree rotation and 1 mm translation. (C) Targeting accuracy for targets at the isocenter is 0.67 mm, within the machine specification of 0.75 mm. Targeting accuracy for isocenters 6-12 cm away from the target is in the range 0.67-1.18 mm. CONCLUSION (A) Single isocenter HyperArc treatments for multiple brain metastases are feasible and targeting accuracy is clinically acceptable. (B) The vertex in a cranial scan is very important for proper alignment.
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Affiliation(s)
- Fang Li
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Noor Mail
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | | | - Travis J. McCaw
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Cihat Ozhasoglu
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Ronald Lalonde
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Jina Chang
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Mohammed Saiful Huq
- Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
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Akdeniz Y, Ispir B. Whole-brain radiotherapy with hippocampus sparing and simultaneous integrated boost to metastases: A plan quality comparison study between Ethos, HyperArc, VMAT and Tomotherapy. Med Dosim 2023:S0958-3947(23)00112-7. [PMID: 38101995 DOI: 10.1016/j.meddos.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023]
Abstract
This study provides a concise and structured overview of a dosimetric comparison study conducted to assess the feasibility and effectiveness of 4 advanced radiotherapy techniques in treating brain metastases with hippocampus sparing and simultaneous integrated boost (HS-WBRT+SIB). Eleven patients with brain metastases previously treated with radiotherapy were included in the study. Planning CT scans with 2 mm slice thickness and MR imaging were used for contouring and dose prescription. The bilateral hippocampus and other organs at risk (OARs) were automatically contoured, and hippocampal avoidance regions (HAR) were defined as a 7 mm 3D expansion around the hippocampus. Gross tumor volume for each metastasis (GTVmet) and planning target volume for metastases (PTVmet) were delineated. The whole-brain CTV (CTVWB) and planning target volume for whole brain (PTVWB) were defined accordingly. Treatment planning and optimization were conducted using state-of-the-art radiotherapy techniques: Ethos, HyperArc, VMAT, and Tomotherapy. Tomotherapy achieved the highest D98% for PTVmet, indicating the best metastasis coverage. HyperArc plans showed the highest D98% for PTVWB, suggesting superior whole-brain coverage. Tomotherapy demonstrated significantly lower D98%, D2%, and Dmean values for the hippocampus, indicating its superiority in sparing the hippocampus. VMAT resulted in the lowest D2% values for the eyes, optic nerves, brainstem, and hypophysis, showing the best sparing of these critical structures. Tomotherapy consistently achieved lower Dmean values for parotids, oral cavity, and lips compared to the other techniques. The dosimetric comparison revealed distinct strengths and weaknesses for each radiotherapy technique. Tomotherapy excelled in sparing the hippocampus, while VMAT showed promise in sparing OARs. HyperArc plans demonstrated the best overall whole-brain coverage. These findings should guide clinicians in selecting the most suitable technique based on patient characteristics and institutional resources.
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Affiliation(s)
- Yucel Akdeniz
- Radiation Oncology Department, Acıbadem Adana Hospital, Adana, Turkey.
| | - Burcin Ispir
- Radiation Oncology Department, Acıbadem Ataşehir Hospital, İstanbul, Turkey
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Pokhrel D, Misa J, McCarthy S, Yang ES. Two novel stereotactic radiotherapy methods for locally advanced, previously irradiated head and neck cancers patients. Med Dosim 2023; 49:114-120. [PMID: 37867087 DOI: 10.1016/j.meddos.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023]
Abstract
To determine the feasibility and utility of conebeam CT-guided stereotactic radiotherapy for locally recurrent, previously irradiated head and neck cancer (HNC) patients on the Halcyon, a ring delivery system (RDS). This research aims to quantify plan quality, treatment delivery accuracy, and overall efficacy by comparing against novel clinical TrueBeam HyperArc method. Ten recurrent HNC patients who were treated at our institution on TrueBeam (6MV-FFF) for 30 to 40 Gy in 3 to 5 fractions with noncoplanar HyperArc plans were re-planned on Halcyon (6MV-FFF). These plans were re-planned with the same Acuros-based dose engine. Additionally, we used site-specific full/partial coplanar VMAT arcs. PTV coverage, mean dose to GTV, maximum dose to organs-at-risk (OAR), beam-on time (BOT), and quality assurance (QA) results were investigated and compared. Halcyon provided highly conformal HNC SRT plans with slightly superior mean PTVD99 coverage (96.7% vs 95.5%, p = 0.071), and slightly lower mean GTV dose (37.8 Gy vs 38.2 Gy, p = 0.241) when compared to the HyperArc plans. Differences in plan conformality and maximum dose to OARs were statistically insignificant. Due to Halcyon's coplanar geometry, D2cm was significantly higher (p = 0.001) but Halcyon did result in a reduced normal brain dose by 1 Gy on average and up to 5.2 Gy in some cases. Halcyon provided similar patient-specific QA pass rates with a 2%/2mm gamma criteria (98.2% vs 98.5%) and independent in-house Monte Carlo second check results (97.7% vs 98.2%), suggesting identical treatment delivery accuracy. Halcyon plans resulted in slightly longer beam-on time (3.16 vs 2.30 minutes, p = 0.010), however door-to-door patient time is expected to be <10 minutes. Compared to clinical TrueBeam HyperArc, Halcyon SRT plans provided similar plan quality and treatment delivery accuracy with a potentially faster overall treatment using fully automated patient setup and verification. Rapid delivery of recurrent HNC SRT may reduce intrafraction motion errors while also improving patient compliance and comfort. To provide high-quality of HNC SRT similar to HyperArc, we recommend Halcyon users consider commissioning this novel method. This method will be useful for remote and underserved patient cohorts including Halcyon-only clinics as well.
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Affiliation(s)
- Damodar Pokhrel
- Department of Radiation Medicine, Medical Physics Graduate Program, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
| | - Josh Misa
- Department of Radiation Medicine, Medical Physics Graduate Program, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - Shane McCarthy
- Department of Radiation Medicine, Medical Physics Graduate Program, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - Eddy S Yang
- Department of Radiation Medicine, Medical Physics Graduate Program, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA
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Xu Q, Baldvinsson G, Piracha NZ, Logadóttir Á, Henrysdóttir HB. Patient-specific QA for the HyperArc technique using gafchromic film with multiple calibration methods. Acta Oncol 2023; 62:1215-1221. [PMID: 37672563 DOI: 10.1080/0284186x.2023.2254484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE This study aims to evaluate different methods for calibrating EBT-XD films to develop a precise pre-treatment verification method for stereotactic radiotherapy (SRT) patients using the HyperArc (HA, Varian Medical System) technique. METHODS Gafchromic EBT-XD films were calibrated using three different approaches: manual calibration, EDW calibration, and PDD calibration. Films were digitalized with an Epson V850 Pro scanner applying the local scanning protocol. Three clinical treatment plans were selected for evaluation. Patient-specific QA films were irradiated in the Mobius MVP phantom and the STEEV phantom. Scanned film images were converted into dose images using the calibration curves. Gamma analysis was performed to compare film dose and TPS calculated dose with various criteria. RESULTS The scan-to-scan variation was evaluated to be ≤ 0.2%. The accuracy of the calibration curves was verified and the deviation from the converted dose deviates ≤ 3% from the known delivered dose. The gamma passing rate for all calibration methods was found to be over 94% with clinically relevant criteria. EDW calibration demonstrated higher average gamma passing rates compared to the manual method for single target plans, which is 99% ± 1.2% and 98.8% ± 1.5%, respectively. PDD method demonstrated improved agreement for multiple targets with the result of 99.3% ± 0.8%. CONCLUSIONS The three calibration methods were validated, and they produced accurate calibration curves for EBT-XD films to enable pre-treatment patient-specific QA for stereotactic radiotherapy.
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Affiliation(s)
- Qiuyi Xu
- Department of Radiotherapy, Landspitali University Hospital, Reykjavik, Iceland
| | - Gauti Baldvinsson
- Department of Radiotherapy, Landspitali University Hospital, Reykjavik, Iceland
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Kim J, Kim TG, Park B, Kim H, Song YG, Lee HW, Kim YZ, Ji JH, Kim SH, Kim SM, Lee JH, Kim H. Dosimetric comparison between RapidArc and HyperArc in hippocampal-sparing whole-brain radiotherapy with a simultaneous integrated boost. Med Dosim 2023; 49:69-76. [PMID: 37718172 DOI: 10.1016/j.meddos.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
The HyperArc technique is known for generating high-quality radiosurgical treatment plans for intracranial lesions or hippocampal-sparing whole-brain radiotherapy (WBRT). However, there is no reported feasibility of using the HyperArc technique in hippocampal-sparing WBRT with a simultaneous integrated boost (SIB). This study aimed to compare dosimetric parameters of 2 commercially-available volumetric-modulated arc radiotherapy techniques, HyperArc and RapidArc, when using hippocampal-sparing WBRT with a SIB to treat brain metastases. Treatment plans using HyperArc and RapidArc techniques were generated retrospectively for 19 previously treated patients (1 to 3 brain metastases). The planning target volumes for the whole brain (excluding the hippocampal avoidance region; PTVWB) and metastases (PTVmet) were prescribed 25 and 45 Gy, respectively, in 10 fractions. Each plan included homogeneous and inhomogeneous delivery to the PTVmet. Dosimetric parameters for the target (conformity index [CI], homogeneity index [HI], target coverage [D95%]), and nontarget organs at risk were compared for the HyperArc and RapidArc plans. For homogeneous delivery, dosimetric parameters, including mean CI, HI, and target coverage in PTVWB and PTVmet, were superior for HyperArc than RapidArc plans (all p < 0.01). The PTVWB and PTVmet target coverage for HyperArc plans was significantly greater than for RapidArc plans (96.17% vs 93.38%, p < 0.01; 94.02% vs 92.21%, p < 0.01, respectively). HyperArc plans had significantly lower mean hippocampal Dmax and Dmin values than RapidArc plans (Dmax: 15.53 Gy vs, 16.71 Gy, p < 0.01; Dmin: 8.33 Gy vs 8.93 Gy, p < 0.01, respectively). Similarly, inhomogeneous delivery of hyperArc produced a superior target and lower hippocampal dosimetric parameters than RapidArc, except for the HI of PTVmet (all p < 0.01). HyperArc generated superior conformity and target coverage with lower hippocampal doses than RapidArc. HyperArc could be an attractive technique for hippocampal-sparing WBRT with an SIB.
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Affiliation(s)
- Jeongho Kim
- Departments of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Tae Gyu Kim
- Departments of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
| | - Byungdo Park
- Departments of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Hyunjung Kim
- Departments of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Yun Gyu Song
- Departments of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Hyoun Wook Lee
- Departments of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Young Zoon Kim
- Departments of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jun Ho Ji
- Departments of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Seok-Hyun Kim
- Departments of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Sung Min Kim
- Departments of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jun Ho Lee
- Departments of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Yamada T, Nakano H, Tanabe S, Sakai T, Tanabe S, Oka T, Sakai H, Oshikane T, Nakano T, Ohta A, Kanazawa T, Kaidu M, Ishikawa H. Verification of Qfix Encompass™ couch modeling using the Acuros XB algorithm and HypeArc™ using a high-spatial-resolution two-dimensional diode array. Med Dosim 2023; 48:261-266. [PMID: 37455221 DOI: 10.1016/j.meddos.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/15/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
We modeled the Qfix Encompass™ immobilization system and further verified the calculated dose distribution of the AcurosXB (AXB) dose calculation algorithm using SRS MapCHECKⓇ (SRSMC) in the HyperArc™ (HA) clinical plan. An Encompass system with a StereoPHAN™ QA phantom was scanned by SOMATOM go.Sim and imported to an Eclipse™ treatment planning system to create a treatment plan for Encompass modeling. The Encompass modeling was performed in the StereoPHAN with a pinpoint ion chamber for 6 MV and 6 MV flattening filter free (6 MV FFF), and 2 × 2 cm2, 4 × 4 cm2, and 6 × 6 cm2 irradiation field sizes. The dose calculation algorithm used was AXB ver. 15.5 with a 1.0 mm calculation grid size. The Hounsfield unit (HU) values of the Encompass modeling were set to 400, -100, -200, and -300 for Encompass, and -400, -600, -700, and -800 for the Encompass base. We evaluated the dose distribution after Encompass modeling by SRSMC using gamma analysis in 12 patients. We adopted HU values of -200 for Encompass, -800 for Encompass base for 6 MV, and -200 for Encompass and -700 for Encompass. Base for 6 MV FFF was adopted as the HU values for the Encompass modeling based on the measurement results. The proposed Encompass modeling resulted in a mean pass rate evaluation >98% for both 6 MV and 6 MV FFF when the 1%/1 mm criterion was used, demonstrating that the proposed HU value can be adopted to calculate more accurate dose distributions.
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Affiliation(s)
- Takumi Yamada
- Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Hisashi Nakano
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan; Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan.
| | - Satoshi Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
| | - Tatsuya Sakai
- Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Shunpei Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
| | - Tetsuya Oka
- Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Hironori Sakai
- Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Tomoya Oshikane
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
| | - Toshimichi Nakano
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8122, Japan
| | - Atsushi Ohta
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
| | - Tsutomu Kanazawa
- Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Motoki Kaidu
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8122, Japan
| | - Hiroyuki Ishikawa
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8122, Japan
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10
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Inui S, Takahashi Y, Ueda Y, Ohira S, Washio H, Ono S, Miyazaki M, Nishio T, Koizumi M, Konishi K. Dosimetric Comparison of Helical Tomotherapy and HyperArc Treatment Plans for Angiosarcoma of the Scalp. Anticancer Res 2023; 43:3079-3087. [PMID: 37351970 DOI: 10.21873/anticanres.16479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND/AIM Angiosarcoma of the scalp (AS) is a rare tumor that has often been treated by total scalp irradiation (TSI). TSI has technical and dosimetric challenges. This study aimed to compare the dosimetric performance of helical tomotherapy (HT) plans with that of HyperArc (HA) plans for TSI in AS. PATIENTS AND METHODS A planning study was conducted for 11 patients with AS (70 Gy/35 fr). HT and HA planning was performed using TomoHDA and TrueBeam Edge systems, respectively. The performance of three different plans were compared: HT, HA, and HA with half-field beams (HF-HA). The dose distribution and dosimetric parameters for each plan were evaluated. RESULTS All constraint parameters for the target and organs at risk (OARs) met the goals within acceptable limits for the three techniques. The HA and HF-HA plans provided significantly lower mean brain dose (12.46±2.48 Gy and 8.02±1.48 Gy) than did the HT plan (17.59±3.47 Gy). The doses receiving 0.1 cc of the volume for brainstem and chiasm were significantly lower in the HA and HF-HA plans than those in the HT plan. The HA and HF-HA plans provided a shorter beam-on time (155±3 s and 181±14 s) than did the HT plan (962±221 s). CONCLUSION The HA plan provided significantly better OARs sparing than the HT plan for TSI in AS and had an advantage to using half-field beams.
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Affiliation(s)
- Shoki Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan;
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yutaka Takahashi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hayate Washio
- Department of Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Shunsuke Ono
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Teiji Nishio
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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11
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Ohira S, Ikawa T, Inui S, Kanayama N, Ueda Y, Miyazaki M, Nishio T, Koizumi M, Konishi K. Improvement of target coverage using automated non-coplanar volumetric modulated arc therapy planning in stereotactic radiotherapy for cervical metastatic spinal tumors. Med Dosim 2023:S0958-3947(23)00039-0. [PMID: 37202230 DOI: 10.1016/j.meddos.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023]
Abstract
This study aimed to compare dosimetric parameters for targets and organs at risk (OARs) between volumetric modulated arc therapy (VMAT) and automated VMAT (HyperArc, HA) plans in stereotactic radiotherapy for patients with cervical metastatic spine tumors. VMAT plans were generated for 11 metastases using the simultaneous integrated boost technique to deliver 35 to 40 and 20 to 25 Gy for high dose and elective dose planning target volume (PTVHD and PTVED), respectively. The HA plans were retrospectively generated using 1 coplanar and 2 noncoplanar arcs. Subsequently, the doses to the targets and OARs were compared. The HA plans provided significantly higher (p < 0.05) Dmin (77.4 ± 13.1%), D99% (89.3 ± 8.9%), and D98% (92.5 ± 7.7%) for gross tumor volume (GTV) than those of the VMAT plans (73.4 ± 12.2%, 84.2 ± 9.6 and 87.3 ± 8.8% for Dmin, D99% and D98%, respectively). In addition, D99% and D98% for PTVHD were significantly higher in the HA plans, whereas dosimetric parameters were comparable between the HA and VMAT plans for PTVED. The Dmax values for the brachial plexus, esophagus, and spinal cord were comparable, and no significant difference was observed in the Dmean for the larynx, pharyngeal constrictor, thyroid, parotid grand (left and right), and Submandibular gland (left and right). The HA plans provided significantly higher target coverage of GTV and PTVHD, with a comparable dose for OARs with VMAT plans. The results of this study may contribute to the improvement of local control in clinical practice.
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Affiliation(s)
- Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan; Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Toshiki Ikawa
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shoki Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Naoyuki Kanayama
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Teiji Nishio
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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12
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Yamamoto Y, Ohira S, Kanayama N, Inui S, Ueda Y, Koike Y, Miyazaki M, Nishio T, Koizumi M, Konishi K. Comparison of dosimetric parameters and robustness for rotational errors in fractionated stereotactic irradiation using automated noncoplanar volumetric modulated arc therapy for patients with brain metastases: single- versus multi-isocentric technique. Radiol Phys Technol 2023; 16:310-318. [PMID: 37093409 DOI: 10.1007/s12194-023-00720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
To compare the dosimetric parameters of automated noncoplanar volumetric modulated arc therapy plans using single-isocentric (SIC) and multi-isocentric (MIC) techniques for patients with two brain metastases (BMs) in stereotactic irradiation and to evaluate the robustness of rotational errors. The SIC and MIC plans were retrospectively generated (35 Gy/five fractions) for 58 patients. Subsequently, a receiver operating characteristic curve analysis between the tumor surface distance (TSD) and V25Gy was performed to determine the thresholds for the brain tissue. The SIC and MIC plans were recalculated based on the rotational images to evaluate the dosimetric impact of rotational error. The MIC plans showed better brain tissue sparing for TSD > 6.6 cm. The SIC plans provided a significantly better conformity index for TSD ≤ 6.6 cm, while significantly lower gradient index was obtained (3.22 ± 0.56vs. 3.30 ± 0.57, p < 0.05) in the MIC plans with TSD > 6.6 cm. For organs at risk (OARs) (brainstem, chiasm, lens, optic nerves, and retinas), D0.1 cc was significantly lower (p < 0.05) in the MIC plans than in the SIC plans. The prescription dose could be delivered (D99%) to the gross tumor volume (GTV) for patients with TSD ≤ 6.6 cm when the rotational error was < 1°, whereas 31% of the D99% of GTV fell below the prescription dose with TSD > 6.6 cm. MIC plans can be an optimal approach for reducing doses to OARs and providing robustness against rotational errors in BMs with TSD > 6.6 cm.
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Affiliation(s)
- Yuki Yamamoto
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan.
| | - Naoyuki Kanayama
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
| | - Shoki Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
| | - Yuhei Koike
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
| | - Teiji Nishio
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan
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13
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Ohira S, Ikawa T, Kanayama N, Inui S, Ueda Y, Miyazaki M, Nishio T, Koizumi M, Konishi K. Dose reduction of hippocampus using HyperArc planning in postoperative radiotherapy for primary brain tumors. Med Dosim 2023:S0958-3947(22)00095-4. [PMID: 36653285 DOI: 10.1016/j.meddos.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 01/18/2023]
Abstract
To compare dosimetric parameters for the hippocampus, organs at risk (OARs), and targets of volumetric modulated arc therapy (VMAT), noncoplanar VMAT (NC-VMAT), and HyperArc (HA) plans in patients undergoing postoperative radiotherapy for primary brain tumors. For 20 patients, HA plans were generated to deliver 40.05 to 60 Gy for the planning target volume (PTV). In addition, doses for the hippocampus and OARs were minimized. The VMAT and NC-VMAT plans were retrospectively generated using the same optimization parameters as those in the HA plans. For the hippocampus, the equivalent dose to be administered in 2 Gy fractions (EQD2) was calculated assuming α/β = 2. Dosimetric parameters for the PTV, hippocampus, and OARs in the VMAT, NC-VMAT, and HA plans were compared. For PTV, the HA plans provided significantly lower Dmax and D1% than the VMAT and NC-VMAT plans (p < 0.05), whereas the D99% and Dmin were significantly higher (p < 0.05). For the contralateral hippocampus, the dosimetric parameters in the HA plans (8.1 ± 9.6, 6.5 ± 7.2, 5.6 ± 5.8, and 4.8 ± 4.7 Gy for D20%, D40%, D60% and D80%, respectively) were significantly smaller (p < 0.05) than those in the VMAT and NC-VMAT plans. Except for the optic chiasm, the Dmax in the HA plans (brainstem, lens, optic nerves, and retinas) was the smallest (p < 0.05). In addition, the doses in the HA plans for the brain and skin were the smallest (p < 0.05) among the 3 plans. HA planning, instead of coplanar and noncoplanar VMAT, significantly reduces the dosage to which the contralateral hippocampus as well as other OARs are exposed without compromising on target coverage.
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14
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Pan M, Xu W, Sun L, Wang C, Dong S, Guan Y, Yang J, Wang E. Dosimetric quality of HyperArc in boost radiotherapy for single glioblastoma: comparison with CyberKnife and manual VMAT. Radiat Oncol 2023; 18:8. [PMID: 36627633 PMCID: PMC9832781 DOI: 10.1186/s13014-022-02150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/24/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Stereotactic radiotherapy (SRT) and hypo-fractionated radiotherapy are feasible treatment options for single glioblastoma multiforme when combined with conventional radiotherapy or delivered alone. HyperArc (HA), a novel linac-based method with 4 noncoplanar arcs, has been introduced into stereotactic radiosurgery (SRS) for single and multiple metastases. In this study, we compared the dosimetric quality of HyperArc with the well-established CyberKnife (CK) and conventional VMAT methods of SRT for a single, large target. METHODS Sixteen patients treated in our center with their clinical CK plans were enrolled, and the linac-based plans were designed in silico. From the aspect of normal tissue protection and treatment efficacy, we compared the conformity index (CI), gradient index (GI), homogeneity index (HI), dose distribution in planning target volume, dose in the normal brain tissue, and mean dose of several organs at risk (OARs). All of the data were evaluated with nonparametric Kruskal‒Wallis tests. We further investigated the relationship of the dose distribution with the tumor volume and its location. RESULTS The results showed that with a higher CI (0.94 ± 0.03) and lower GI (2.57 ± 0.53), the HA plans generated a lower dose to the OARs and the normal tissue. Meanwhile, the CK plans achieved a higher HI (0.35 ± 0.10) and generated a higher dose inside the tumor. Although manual VMAT showed slight improvement in dose quality and less monitoring units (2083 ± 225), HA can save half of the delivery time of CK (37 minutes) on average. CONCLUSION HA plans have higher conformity and spare OARs with lower normal tissue irradiation, while CK plans achieve a higher mean dose in tumors. HA with 4 arcs is sufficient in dosimetric quality for a single tumor with great convenience in planning and treatment processes compared with conventional VMAT. The tumor size and location are factors to be considered when selecting treatment equipment.
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Affiliation(s)
- Mingyuan Pan
- grid.8547.e0000 0001 0125 2443CyberKnife Center, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Neurosurgical Institute, Fudan University, Shanghai, China ,Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, 12 Wulumuqi Road (M), Shanghai, 200040 China
| | - Wenqian Xu
- grid.8547.e0000 0001 0125 2443CyberKnife Center, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Neurosurgical Institute, Fudan University, Shanghai, China ,Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, 12 Wulumuqi Road (M), Shanghai, 200040 China
| | - Lei Sun
- grid.8547.e0000 0001 0125 2443CyberKnife Center, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Neurosurgical Institute, Fudan University, Shanghai, China ,Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, 12 Wulumuqi Road (M), Shanghai, 200040 China
| | - Chaozhuang Wang
- grid.8547.e0000 0001 0125 2443CyberKnife Center, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Neurosurgical Institute, Fudan University, Shanghai, China ,Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, 12 Wulumuqi Road (M), Shanghai, 200040 China
| | - Shengnan Dong
- grid.8547.e0000 0001 0125 2443CyberKnife Center, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Neurosurgical Institute, Fudan University, Shanghai, China ,Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, 12 Wulumuqi Road (M), Shanghai, 200040 China
| | - Yun Guan
- grid.8547.e0000 0001 0125 2443CyberKnife Center, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Neurosurgical Institute, Fudan University, Shanghai, China ,Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, 12 Wulumuqi Road (M), Shanghai, 200040 China
| | - Jun Yang
- Radonc Department, Foshan Chancheng Hospital, 3 Sanyou Road, Foshan, 528000 Guangdong China
| | - Enmin Wang
- grid.8547.e0000 0001 0125 2443CyberKnife Center, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Neurosurgical Institute, Fudan University, Shanghai, China ,Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, 12 Wulumuqi Road (M), Shanghai, 200040 China
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15
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Sagawa T, Ueda Y, Tsuru H, Kamima T, Ohira S, Tamura M, Miyazaki M, Monzen H, Konishi K. Dosimetric potential of knowledge-based planning model trained with HyperArc plans for brain metastases. J Appl Clin Med Phys 2022; 24:e13836. [PMID: 36333969 PMCID: PMC9924102 DOI: 10.1002/acm2.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Dosimetric potential of knowledge-based RapidPlan planning model trained with HyperArc plans (Model-HA) for brain metastases has not been reported. We developed a Model-HA and compared its performance with that of clinical volumetric modulated arc therapy (VMAT) plans. METHODS From 67 clinical stereotactic radiosurgery (SRS) HyperArc plans for brain metastases, 47 plans were used to build and train a Model-HA. The other 20 clinical HyperArc plans were recalculated in RapidPlan system with Model-HA. The model performance was validated with the 20 plans by comparing dosimetric parameters for normal brain tissue between clinical plans and model-generated plans. The 20 clinical conventional VMAT-based SRS or stereotactic radiotherapy plans (CL-VMAT) were reoptimized with Model-HA (RP) and HyperArc system (HA), respectively. The dosimetric parameters were compared among three plans (CL-VMAT vs. RP vs. HA) in terms of planning target volume (PTV), normal brain excluding PTVs (Brain - PTV), brainstem, chiasm, and both optic nerves. RESULTS In model validation, the optimization performance of Model-HA was comparable to that of HyperArc system. In comparison to CL-VMAT, there were no significant differences among three plans with respect to PTV coverage (p > 0.17) and maximum dose for brainstem, chiasm, and optic nerves (p > 0.40). RP provided significantly lower V20 Gy , V12 Gy , and V4 Gy for Brain - PTV than CL-VMAT (p < 0.01). CONCLUSION The Model-HA has the potential to significantly reduce the normal brain dose of the original VMAT plans for brain metastases.
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Affiliation(s)
- Tomohiro Sagawa
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yoshihiro Ueda
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
| | - Haruhi Tsuru
- Department of Medical Physics and EngineeringGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Tatsuya Kamima
- Radiation Oncology DepartmentCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Shingo Ohira
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
| | - Mikoto Tamura
- Department of Medical PhysicsGraduate School of Medical SciencesKindai UniversitySayamaJapan
| | - Masayoshi Miyazaki
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hajime Monzen
- Department of Medical PhysicsGraduate School of Medical SciencesKindai UniversitySayamaJapan
| | - Koji Konishi
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
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16
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Calvo-Ortega JF, Moragues-Femenía S, Laosa-Bello C, Hermida-López M, Pozo-Massó M, Zamora-Pérez A. Monte Carlo-based independent dose verification of radiosurgery HyperArc plans. Phys Med 2022; 102:19-26. [PMID: 36037748 DOI: 10.1016/j.ejmp.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 08/07/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the feasibility of using the free PRIMO Monte Carlo software for independent dose check of cranial SRS plans designed with the Varian HyperArc (HA) technique. MATERIALS AND METHODS In this study, the PRIMO Monte Carlo software v. 0.3.64.1800 was used with the phase-space files (v. 2, Feb. 27, 2013) provided by Varian for 6 MV flattening-filter-free (FFF) photon beams from a Varian TrueBeam linear accelerator (linac), equipped with a Millennium 120 multileaf collimator (MLC). This configuration was validated by comparing the percentage depth doses (PDDs), lateral profiles and relative output factors (OFs) simulated in a water phantom against measurements for field sizes from 1 × 1 to 40 × 40 cm2. The agreement between simulated and experimental relative dose curves was evaluated using a global (G) gamma index analysis. In addition, the accuracy of PRIMO to model the MLC was investigated (dosimetric leaf gap, tongue and groove, leaf transmission and interleaf leakage). Thirty-five HA SRS plans computed in the Eclipse treatment planning system (TPS) were simulated in PRIMO. The Acuros XB algorithm v. 16.10 (dose to medium) was used in Eclipse. Sixty targets with diameters ranging from 6 to 33 mm were included. Agreement between the dose distributions given by Eclipse and PRIMO was evaluated in terms of 3D global gamma passing rates (GPRs) for the 2 %/2 mm criteria. RESULTS Average GPR greater than 95 % with the 2 %(G)/1 mm criteria were obtained over the PDD and profiles of each field size. Differences between PRIMO calculated and measured OFs were within 0.5 % in all fields, except for the 1 × 1 cm2 with a discrepancy of 1.5 %. Regarding the MLC modeling in PRIMO, an agreement within 3 % was achieved between calculated and experimental doses. Excellent agreement between PRIMO and Eclipse was found for the 35 HA plans. The 3D global GPRs (2 %/2 mm) for the targets and external patient contour were 99.6 % ± 1.1 % and 99.8 % ± 0.5 %, respectively. CONCLUSIONS According to the results described in this study, the PRIMO Monte Carlo software, in conjunction with the 6X FFF Varian phase-space files, can be used as secondary dose calculation software to check stereotactic radiosurgery plans from Eclipse using the HyperArc technique.
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Affiliation(s)
- Juan-Francisco Calvo-Ortega
- Servicio de Oncología Radioterápica, Hospital Quirónsalud, Barcelona, Spain; Servicio de Oncología Radioterápica, Hospital Quirónsalud, Málaga, Spain.
| | | | - Coral Laosa-Bello
- Servicio de Oncología Radioterápica, Hospital Quirónsalud, Barcelona, Spain
| | - Marcelino Hermida-López
- Marcelino Hermida-López. Servei de Física i Protecció Radiològica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Miguel Pozo-Massó
- Servicio de Oncología Radioterápica, Hospital Quirónsalud, Barcelona, Spain
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17
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Zirone L, Bonanno E, Borzì GR, Cavalli N, D’Anna A, Galvagno R, Girlando A, Gueli AM, Pace M, Stella G, Marino C. HyperArcTM Dosimetric Validation for Multiple Targets Using Ionization Chamber and RT-100 Polymer Gel. Gels 2022; 8:gels8080481. [PMID: 36005082 PMCID: PMC9407338 DOI: 10.3390/gels8080481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple brain metastases single-isocenter stereotactic radiosurgery (SRS) treatment is increasingly employed in radiotherapy department. Before its use in clinical routine, it is recommended to perform end-to-end tests. In this work, we report the results of five HyperArcTM treatment plans obtained by both ionization chamber (IC) and polymer gel. The end-to-end tests were performed using a water equivalent Mobius Verification PhantomTM (MVP) and a 3D-printed anthropomorphic head phantom PseudoPatient® (PP) (RTsafe P.C., Athens, Greece); 2D and 3D dose distributions were evaluated on the PP phantom using polymer gel (RTsafe). Gels were read by 1.5T magnetic resonance imaging (MRI). Comparison between calculated and measured distributions was performed using gamma index passing rate evaluation by different criteria (5% 2 mm, 3% 2 mm, 5% 1 mm). Mean point dose differences of 1.01% [min −0.77%−max 2.89%] and 0.23% [min 0.01%−max 2.81%] were found in MVP and PP phantoms, respectively. For each target volume, the obtained results in terms of gamma index passing rate show an agreement >95% with 5% 2 mm and 3% 2 mm criteria for both 2D and 3D distributions. The obtained results confirmed that the use of a single isocenter for multiple lesions reduces the treatment time without compromising accuracy, even in the case of target volumes that are quite distant from the isocenter.
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Affiliation(s)
- Lucia Zirone
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Elisa Bonanno
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Giuseppina Rita Borzì
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Nina Cavalli
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Alessia D’Anna
- Department of Physics and Astronomy E. Majorana, University of Catania, 95123 Catania, Italy; (A.D.); (R.G.); (A.M.G.)
| | - Rosaria Galvagno
- Department of Physics and Astronomy E. Majorana, University of Catania, 95123 Catania, Italy; (A.D.); (R.G.); (A.M.G.)
| | - Andrea Girlando
- Radiotherapy Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy;
| | - Anna Maria Gueli
- Department of Physics and Astronomy E. Majorana, University of Catania, 95123 Catania, Italy; (A.D.); (R.G.); (A.M.G.)
| | - Martina Pace
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Giuseppe Stella
- Department of Physics and Astronomy E. Majorana, University of Catania, 95123 Catania, Italy; (A.D.); (R.G.); (A.M.G.)
- Correspondence: ; Tel.: +39-328-1847570
| | - Carmelo Marino
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
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Woods KE, Ma TM, Cook KA, Morris ED, Gao Y, Sheng K, Kishan AU, Hegde JV, Felix C, Basehart V, Narahara K, Shen Z, Tenn S, Steinberg ML, Chin RK, Cao M. A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes. Cancers (Basel) 2022; 14:cancers14040939. [PMID: 35205686 PMCID: PMC8870161 DOI: 10.3390/cancers14040939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The delivery of higher radiation doses has been shown to increase local control, and ultimately survival, for head and neck cancer patients, but highly conformal dose distributions are necessary to minimize normal tissue toxicity. Varian’s HyperArc non-coplanar automated treatment planning and delivery technique has been shown to improve dose conformity for intracranial treatment, but its safety and efficacy for head and neck cancer treatment has yet to be verified. This study evaluates the initial results of a prospective clinical trial using HyperArc for recurrent head and neck cancer patients. We demonstrated that HyperArc can enable significant tumor dose escalation compared to conventional volumetric modulated arc therapy (VMAT) planning while minimizing the dose to organs at risk. Treatment delivery was feasible and safe, with minimal treatment-related toxicities and positive patient-reported quality of life measures. Abstract This study reports the initial results for the first 15 patients on a prospective phase II clinical trial exploring the safety, feasibility, and efficacy of the HyperArc technique for recurrent head and neck cancer treatment. Eligible patients were simulated and planned with both conventional VMAT and HyperArc techniques and the plan with superior dosimetry was selected for treatment. Dosimetry, delivery feasibility and safety, treatment-related toxicity, and patient-reported quality of life (QOL) were all evaluated. HyperArc was chosen over conventional VMAT for all 15 patients and enabled statistically significant increases in dose conformity (R50% reduced by 1.2 ± 2.1, p < 0.05) and mean PTV and GTV doses (by 15.7 ± 4.9 Gy, p < 0.01 and 17.1 ± 6.0 Gy, p < 0.01, respectively). The average HyperArc delivery was 2.8 min longer than conventional VMAT (p < 0.01), and the mean intrafraction motion was ≤ 0.5 ± 0.4 mm and ≤0.3 ± 0.1°. With a median follow-up of 12 months, treatment-related toxicity was minimal (only one grade 3 acute toxicity above baseline) and patient-reported QOL metrics were favorable. HyperArc enabled superior dosimetry and significant target dose escalation compared to conventional VMAT planning, and treatment delivery was feasible, safe, and well-tolerated by patients.
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Affiliation(s)
- Kaley E. Woods
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033, USA
| | - Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Kiri A. Cook
- Department of Radiation Oncology, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Eric D. Morris
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Yu Gao
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - John V. Hegde
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Carol Felix
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Vincent Basehart
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Kelsey Narahara
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Zhouhuizi Shen
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Stephen Tenn
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Michael L. Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Robert K. Chin
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
- Correspondence: (R.K.C.); (M.C.)
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
- Correspondence: (R.K.C.); (M.C.)
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Tejedor-Aguilar N, Lliso F, Ruiz-Rodríguez JC, Gimeno-Olmos J, Carmona V, Bonaque J, Bautista JA, Perez-Calatayud J. Evaluation of intrafraction motion with an open immobilization mask for HyperArc treatment of multiple brain metastases. J Radiosurg SBRT 2022; 8:283-290. [PMID: 37416332 PMCID: PMC10322167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/28/2022] [Indexed: 07/08/2023]
Abstract
Purpose In the implementation of the use of EncompassTM partially open immobilization mask to perform SRS of multiple brain metastasis, the evaluation of patient's intrafraction motion (IM) is deemed convenient to verify that the margins applied to the GTV are able to ensure adequate dose coverage to each lesion. Methods IM was determined by comparing the pre- and post-treatment CBCT images with respect to the simulation CT for a total of 23 fractions. The dosimetric impact on GTV coverage due to translational errors in patient positioning and rotational uncertainties of LINAC's performance was also evaluated. Results The absolute magnitude of IM was less than 1 mm in all cases. The dosimetric difference on GTV coverage due to patient's IM was inferior to 5%. There was not found any significant correlation between the dosimetric impact of rotational uncertainties with the distance to the isocenter. Conclusion The margins applied to the GTV are adequate when using EncompassTM immobilization device.
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Affiliation(s)
- Natalia Tejedor-Aguilar
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Françoise Lliso
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Juan C. Ruiz-Rodríguez
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jose Gimeno-Olmos
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Vicente Carmona
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jorge Bonaque
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Juan A. Bautista
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jose Perez-Calatayud
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Radiation Oncology Department, Clinica Benidorm, Av. Alfonso Puchades, 8, 03501 Alicante, Spain
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Rusu I, Roeske J, Solanki A, Kang H. Fully automated planning and delivery of hippocampal-sparing whole brain irradiation. Med Dosim 2021; 47:8-13. [PMID: 34481718 DOI: 10.1016/j.meddos.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
The goal of this study is to fully automate the treatment planning and delivery process of hippocampal-sparing whole brain irradiation (HS-WBRT) by combining a RapidPlan (RP) knowledge-based planning model and HyperArc (HA) technology. Additionally, this study compares the dosimetric performance of RapidPlan-HyperArc (RP-HA) treatment plans with RP plans and volumetric modulated arc therapy (VMAT) plans. Ten patients previously treated with HS-WBRT using conventional VMAT were re-planned using RP-HA technique and RP model for HS-WBRT. Treatment plans were generated for 30Gy in 3Gy fractions using 6MV photon beam on a TrueBeam linear accelerator (Varian Medical Systems, Palo Alto, CA) equipped with high definition multileaf collimator (HDMLC). Target coverage, homogeneity index (HI), Paddick Conformity index (CI), dose to organs-at-risk (OARs) provided by the 3 planning modalities were compared, and a paired t-test was performed. Total number of monitor units (MU), effective planning time and beam-on-time time were reported and evaluated for each plan. RP-HA plans achieved on average a 4% increase in D98% of PTV, a 26% improvement in HI, a 2.3% increase in CI, when compared to RP plans. Furthermore, RP-HA plans provided on average 11% decrease in D100% of hippocampi when compared to VMAT plans. All RP-HA plans were generated in less than 30 minutes while RP plans took 40 minutes and VMAT plans required on average 9 hours to complete. Regarding beam-on-time time, it was estimated that RP-HA plans take on average 5 minutes to deliver while RP and VMAT plans require 6.5 and 10 minutes, respectively. RP-HA method provides fully automated planning and delivery for HS-WBRT. The auto-generated plans together with automated treatment delivery allow standardization of plan quality, increased efficiency and ultimately improved patient care.
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Affiliation(s)
- Iris Rusu
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, 60153 USA.
| | - John Roeske
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardine Cancer Center, Loyola University Chicago, Maywood, IL, 60153 USA
| | - Abhishek Solanki
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardine Cancer Center, Loyola University Chicago, Maywood, IL, 60153 USA
| | - Hyejoo Kang
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, 60153 USA
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21
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Woods K, Chin RK, Cook KA, Sheng K, Kishan AU, Hegde JV, Tenn S, Steinberg ML, Cao M. Automated Non-Coplanar VMAT for Dose Escalation in Recurrent Head and Neck Cancer Patients. Cancers (Basel) 2021; 13:cancers13081910. [PMID: 33921062 PMCID: PMC8071369 DOI: 10.3390/cancers13081910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary The ability to escalate the radiation dose to head and neck tumors has been shown to offer improved local control, and consequently, survival for recurrent head and neck cancer (rHNC) patients. This study evaluates the HyperArc automated non-coplanar planning technique (originally developed for intracranial treatment) for 20 rHNC patients, and compares this technique to conventional planning methods. HyperArc enables significant tumor dose escalation, with average increases in mean target dose of over 11.5 Gy (26%), while maintaining clinically-equivalent doses to nearby organs. Our results show that the average probability of tumor control is 23% higher for HyperArc than conventional techniques. Abstract This study evaluates the potential for tumor dose escalation in recurrent head and neck cancer (rHNC) patients with automated non-coplanar volumetric modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) planning (HyperArc). Twenty rHNC patients are planned with conventional VMAT SBRT to 40 Gy while minimizing organ-at-risk (OAR) doses. They are then re-planned with the HyperArc technique to match these minimal OAR doses while escalating the target dose as high as possible. Then, we compare the dosimetry, tumor control probability (TCP), and normal tissue complication probability (NTCP) for the two plan types. Our results show that the HyperArc technique significantly increases the mean planning target volume (PTV) and gross tumor volume (GTV) doses by 10.8 ± 4.4 Gy (25%) and 11.5 ± 5.1 Gy (26%) on average, respectively. There are no clinically significant differences in OAR doses, with maximum dose differences of <2 Gy on average. The average TCP is 23% (± 21%) higher for HyperArc than conventional plans, with no significant differences in NTCP for the brainstem, cord, mandible, or larynx. HyperArc can achieve significant tumor dose escalation while maintaining minimal OAR doses in the head and neck—potentially enabling improved local control for rHNC SBRT patients without increased risk of treatment-related toxicities.
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Affiliation(s)
- Kaley Woods
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA; (K.W.); (R.K.C.); (K.S.); (A.U.K.); (J.V.H.); (S.T.); (M.L.S.)
| | - Robert K. Chin
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA; (K.W.); (R.K.C.); (K.S.); (A.U.K.); (J.V.H.); (S.T.); (M.L.S.)
| | - Kiri A. Cook
- Department of Radiation Oncology, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA; (K.W.); (R.K.C.); (K.S.); (A.U.K.); (J.V.H.); (S.T.); (M.L.S.)
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA; (K.W.); (R.K.C.); (K.S.); (A.U.K.); (J.V.H.); (S.T.); (M.L.S.)
| | - John V. Hegde
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA; (K.W.); (R.K.C.); (K.S.); (A.U.K.); (J.V.H.); (S.T.); (M.L.S.)
| | - Stephen Tenn
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA; (K.W.); (R.K.C.); (K.S.); (A.U.K.); (J.V.H.); (S.T.); (M.L.S.)
| | - Michael L. Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA; (K.W.); (R.K.C.); (K.S.); (A.U.K.); (J.V.H.); (S.T.); (M.L.S.)
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA; (K.W.); (R.K.C.); (K.S.); (A.U.K.); (J.V.H.); (S.T.); (M.L.S.)
- Correspondence:
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Sprowls CJ, Shah AP, Kelly P, Burch DR, Mathews RS, Swanick CW, Meeks SL. Whole brain radiotherapy with hippocampal sparing using Varian HyperArc. Med Dosim 2021; 46:264-268. [PMID: 33771435 DOI: 10.1016/j.meddos.2021.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/08/2021] [Accepted: 02/05/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this work was to evaluate using Varian HyperArc as a planning and treatment solution for whole brain radiotherapy (WBRT) with hippocampal sparing following Radiation Therapy Oncology Group (RTOG) 0933 dosimetric criteria. Ten patients previously treated for intracranial lesions were retrospectively planned for WBRT with hippocampal sparing using HyperArc and a 2-arc coplanar VMAT technique. The whole brain and hippocampus were delineated on fused MRI and CT datasets. The planning target volume (PTV), defined as the whole brain excluding the hippocampal avoidance region, was prescribed 30 Gy in 10 fractions. Plans were evaluated using dosimetric parameters which included the volume of 105% of the prescription dose (V105%) and the maximum dose to the PTV, and the minimum dose to the hippocampus. The planning time, delivery time, and delivery quality assurance (QA) results were also evaluated. Statistical significance was performed between the HyperArc and coplanar VMAT metrics using the Wilcoxon signed-rank test with a significance level of 0.05. All plans met RTOG 0933 dosimetric criteria. HyperArc plans demonstrated significant improvements in PTV dosimetric quality which included a reduced V105% of 6 ± 7% and decreased maximum dose of 1.3 ± 0.3 Gy, compared to coplanar VMAT. Significant OAR sparing was also found for HyperArc plans that included a decreased minimum dose to the hippocampus of 0.3 ± 0.3 Gy. Coplanar VMAT plans resulted in significantly shorter planning and delivery times, compared to HyperArc, by 2.4 minutes and 1.5 minutes, respectively. No significant difference was found between the delivery QA results. This study demonstrated using Varian HyperArc as a planning and treatment solution for WBRT with hippocampal sparing following RTOG 0933 dosimetric criteria. The primary advantages of WBRT with hippocampal sparing using HyperArc, compared to coplanar VMAT, are the gains in OAR sparing and reduced high dose volumes to the PTV.
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Affiliation(s)
- Cameron J Sprowls
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA.
| | - Amish P Shah
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
| | - Patrick Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
| | - Doug R Burch
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
| | - Ryan S Mathews
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
| | - Cameron W Swanick
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
| | - Sanford L Meeks
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
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Komiyama R, Ohira S, Ueda H, Kanayama N, Masaoka A, Isono M, Ueda Y, Miyazaki M, Teshima T. Intra-fractional patient motion when using the Qfix Encompass immobilization system during HyperArc treatment of patients with brain metastases. J Appl Clin Med Phys 2021; 22:254-260. [PMID: 33656261 PMCID: PMC7984469 DOI: 10.1002/acm2.13143] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose This study investigated the intra‐fractional motion (IM) of patients immobilized using the QFix Encompass Immobilization System during HyperArc (HA) treatment. Method HA treatment was performed on 89 patients immobilized using the Encompass. The IM during treatment (including megavoltage (MV) registration) was analyzed for six degrees of freedom including three axes of translation (anterior‐posterior, superior‐inferior (SI) and left‐right (LR)) and three axes of rotation (pitch, roll, and yaw). Then, the no corrected IM (IMNC) was retrospectively simulated (excluding MV registration) in three directions (SI, LR, and yaw). Finally, the correlation between the treatment time and the IM of the 3D vector was assessed. Results The average IM in terms of the absolute displacement were 0.3 mm (SI), 0.3 mm (LR) and 0.2° (yaw) for Stereotactic radiosurgery (SRS), and 0.3 mm (SI), 0.2 mm (LR), and 0.2° (yaw) for stereotactic radiotherapy (SRT). The absolute maximum values of IM were <1 mm along the SI and LR axes and <1° along the yaw axis. The absolute maximum displacements for IMNC were >1 mm along the SI and LR axes and >1° along the yaw axis. In the correlation between the treatment time and the IM, the r‐values were −0.025 and 0.027 for SRS and SRT respectively, along the axes of translation. For the axes of rotation, the r‐values were 0.012 and 0.206 for SRS and SRT, respectively. Conclusion Encompass provided patient immobilization with adequate accuracy during HA treatment. The absolute maximum displacement IM was less than IMNC along the translational/rotational axes, and no statistically significant relationship between the treatment time and the IM was observed.
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Affiliation(s)
- Riho Komiyama
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hikari Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Naoyuki Kanayama
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Masaoka
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masaru Isono
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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Alongi F, Nicosia L, Figlia V, Giaj-Levra N, Cuccia F, Mazzola R, Ricchetti F, Rigo M, Vitale C, De Simone A, Naccarato S, Sicignano G, Gurrera D, Corradini S, Ruggeri R. Long-term disease outcome and volume-based decision strategy in a large cohort of multiple brain metastases treated with a mono-isocentric linac-based Stereotactic Radiosurgery technique. Clin Transl Oncol 2021; 23:1561-1570. [PMID: 33570720 DOI: 10.1007/s12094-020-02550-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Radiosurgery (SRS) is an effective treatment option for brain metastases (BMs). Long-term results of the first worldwide experience with a mono-isocentric, non-coplanar, linac-based stereotactic technique in the treatment of multiple BMs are reported. METHODS patients with multiple BMs, life expectancy > 3 months, and good performance status (≤ 2) were treated with simultaneous SRS with volumetric modulated arc technique. Data were retrospectively evaluated. RESULTS 172 patients accounting for 1079 BMs were treated at our institution from 2017 to 2020. The median number of treated metastases was 4 (range 2-22). Primary tumor histology was: lung (44.8%), breast (32%), and melanoma (9.4%). The 2-year LPFS was 71.6%, respectively. A biological effective dose (BED) ≥ 51.3 Gy10 correlated with higher local control. Uncontrolled systemic disease and melanoma histology were independent prognostic factors correlated with decreased iPFS. Patients with > 10 BMs had a trend towards shorter iPFS (p = 0.055). 31 patients received multiple SRS courses (2-7) in case of intracranial progression. The median iOS was 22.4 months. Brainstem metastases and total PTV > 7.1 cc correlated with shorter iOS. The 1- and 2-year WBRT-free survival was 83.2% and 61.1%, respectively. CONCLUSION Long-term results in a large patient population treated with a mono-isocentric, dedicated technique demonstrated its effectiveness and safety also in the case of multiple courses. The shortened treatment time and the possibility to safely spare healthy brain tissue allows the safe treatment of patients with a large number of metastases and to deliver multiple courses of SRS. In selected cases, the administration of WBRT can be delayed.
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Affiliation(s)
- F Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.,University of Brescia, Brescia, Italy
| | - L Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.
| | - V Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - N Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - F Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - R Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - F Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - M Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - C Vitale
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - A De Simone
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - S Naccarato
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - G Sicignano
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - D Gurrera
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - S Corradini
- Radiation Oncology Department, University Hospital, LMU Munich, Munich, Germany
| | - R Ruggeri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
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Boczkowski A, Kelly P, Meeks SL, Erhart K, Bova FJ, Willoughby TR. Proton vs Hyperarc™ radiosurgery: A planning comparison. J Appl Clin Med Phys 2020; 21:96-108. [PMID: 33151014 PMCID: PMC7769415 DOI: 10.1002/acm2.13075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022] Open
Abstract
For many patients, stereotactic radiosurgery (SRS) offers a minimally invasive, curative option when surgical techniques are not possible. To date, the literature supporting the efficacy and safety of SRS treatment techniques uses photon beams. However, with the number of proton therapy facilities exponentially growing and the favorable physical properties of proton beam radiation therapy, there is an opportunity to develop proton therapy techniques for SRS. The goal of this paper is to determine the ability of clinical proton treatment planning systems to model small field dosimetry accurately and to compare various planning metrics used to evaluate photon SRS to determine the optimum beam configurations and settings for proton SRS (PSRS) treatment plans. Once established, these plan settings were used to perform a planning comparison on a variety of different SRS cases and compare SRS metrics between the PSRS plans and HyperArc™ (VMAT) SRS plans.
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Affiliation(s)
- A. Boczkowski
- Department of NeurosurgeryUniversity of FloridaGainesvilleFLUSA
| | - P. Kelly
- UF Health Cancer Center–Orlando HealthOrlandoFLUSA
| | - S. L. Meeks
- UF Health Cancer Center–Orlando HealthOrlandoFLUSA
| | | | - F. J. Bova
- Department of NeurosurgeryUniversity of FloridaGainesvilleFLUSA
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Ho HW, Yang CC, Lin HM, Chen HY, Huang CC, Wang SC, Lin YW. The feasibility and efficacy of new SBRT technique HyperArc for recurrent nasopharyngeal carcinoma: noncoplanar cone-based robotic system vs. noncoplanar high-definition MLC based Linac system. Med Dosim 2020; 46:164-170. [PMID: 33208290 DOI: 10.1016/j.meddos.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/15/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to evaluate the feasibility and efficacy of HyperArc (HA) for recurrent nasopharyngeal cancer (NPC) by comparing it with the CyberKnife system (CK). Fifteen patients with recurrent nasopharyngeal cancer who were treated using the noncoplanar cone-based robotic CK system were enrolled. CK was delivered with a median dose of 37.5 Gy in 5 fractions. The delivered CK treatment plans were the sources for the corresponding homogeneous HA (HA-H) and inhomogeneous HA (HA-IH) plans. The HA-H plans were generated to meet the corresponding treatment plan criteria for the CK plans. The HA-IH plans were designed to emulate the corresponding inhomogeneous CK isodose distributions. These three SBRT treatment plans were compared with target coverage, sparing of organs at risk (OARs), and dose distribution metrics. The HA-H and HA-IH plans consistently exhibited CTV and PTV coverage levels similar or better to those of the CK plans but significantly reduced the dose to OARs. Using the HA techniques (both HA-H and HA-IH plans), the mean maximal doses to the spinal cord, brainstem, optic nerves, and optic chiasm were reduced by approximately 60%, compared to the CK plans. The high dose spillage, conformity, and homogeneity indices of the HA-H plans were significantly better than those of the CK plans. The HA-IH plans showed faster dose falloff and similar conformity of the HA-H plans and dose heterogeneity of the CK plans. Here we demonstrated the HA treatment plan system for recurrent NPC is feasible, either homogeneous or inhomogeneous delivery. Excellent sparing of OARs and dosimetric distribution and very efficient delivery make HA an attractive SBRT technique for recurrent NPC treatment.
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Affiliation(s)
- Hsiu-Wen Ho
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Ching-Chieh Yang
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan City 71004, Taiwan; Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hsiu-Man Lin
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Hsiao-Yun Chen
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Chun-Chiao Huang
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Shih-Chang Wang
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Yu-Wei Lin
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan City 71004, Taiwan; Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan; Department of Health and Nutrition, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
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27
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Inui S, Ueda Y, Ohira S, Tsuru H, Isono M, Miyazaki M, Koizumi M, Teshima T. Novel strategy with the automatic non-coplanar volumetric-modulated arc therapy for angiosarcoma of the scalp. Radiat Oncol 2020; 15:175. [PMID: 32680542 PMCID: PMC7367225 DOI: 10.1186/s13014-020-01614-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022] Open
Abstract
Background Total scalp irradiation presents technical and dosimetric challenges. While reports suggest that HyperArc, a new stereotactic radiosurgery planning technique applied to non-coplanar volumetric-modulated arc therapy (VMAT) technique, is associated with high conformity and rapid dose fall-off, the performance of HyperArc for total scalp irradiation has not been explored. The current study aimed to compare the dosimetric performance of HyperArc plans with those of non-coplanar VMAT plans in angiosarcoma of the scalp. Methods Ten patients with angiosarcoma of the scalp were included in this study. The performance of three different plans administered using TrueBeam Edge were compared: non-coplanar VMAT using flattening filter (FF) beams (VMAT-FF), HyperArc using FF beams (HyperArc-FF), and HyperArc using flattening filter free (FFF) beams (HyperArc-FFF). The dose distribution, dosimetric parameters, and dosimetric accuracy for each of these plans were evaluated. Results The three plans showed no statistically significant differences in target volume coverage, conformity, and homogeneity. The HyperArc-FF and HyperArc-FFF plans provided significantly lower mean brain doses (12.63 ± 3.31 Gy and 12.71 ± 3.40 Gy) than did the VMAT-FF plans (17.11 ± 5.25 Gy). There were almost no differences in sparing the organs at risk between the HyperArc-FF and HyperArc-FFF plans. The HyperArc-FF and HyperArc-FFF plans provided a shorter beam-on time than did the VMAT-FF plan. The 3%/2 mm gamma test pass rates were above 95% for all three plans. Conclusions Our results suggest that the HyperArc plan can be potentially used for radiation therapy of target regions with large and complicated shapes, such as the scalp, and that there are no advantages of using FFF beams.
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Affiliation(s)
- Shoki Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan.,Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan.
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Haruhi Tsuru
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaru Isono
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
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Ho HW, Lee SP, Lin HM, Chen HY, Huang CC, Wang SC, Yang CC, Lin YW. Dosimetric comparison between RapidArc and HyperArc techniques in salvage stereotactic body radiation therapy for recurrent nasopharyngeal carcinoma. Radiat Oncol 2020; 15:164. [PMID: 32641082 PMCID: PMC7346374 DOI: 10.1186/s13014-020-01602-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/23/2020] [Indexed: 12/31/2022] Open
Abstract
Background To evaluate dosimetric differences of salvage irradiations using two commercially available volumetric modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) techniques: RapidArc (RA) and HyperArc (HA), for recurrent nasopharyngeal carcinoma (NPC) after initial radiation therapy. Methods Ten patients with recurrent NPC status previously treated with radiation therapy were considered suitable candidates for salvage SBRT using VMAT approach. Two separate treatment plans were created with HA and RA techniques for each case, with dosimetric outcomes compared with respect to tumor target coverage and organs-at-risk (OARs) sparing. Furthermore, the cumulative radiobiological effects to the relevant OARs from the original radiotherapy to the respective salvage SBRT plans were analyzed in terms of biologically effective dose (BED). Results Treatment with HA exhibited similar target dose coverage as with RA, while delivering a higher mean dose to the targets. Using RA technique, the mean maximal doses to optic apparatus and the mean brain dose were reduced by 1 to 1.5 Gy, comparing to HA technique. The conformity index, gradient radius, and intermediate dose spillage in HA plans were significantly better than those in RA. With HA technique, the volume of brain receiving 12 Gy or more was reduced by 44%, comparing to RA technique. The cumulative BEDs to spinal cord and optic apparatus with RA technique were 1 to 2 Gy3 less than those with HA. HA technique significantly reduced the volume within body that received more than 100 Gy. Conclusions With better dose distribution than RA while maintaining sufficient target dose coverage, HA represents an attractive salvage SBRT technique for recurrent NPC.
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Affiliation(s)
- Hsiu-Wen Ho
- Department of Radiation Oncology, Chi Mei Medical Center, No.901, Jhonghua Rd., Yongkang Dist., Tainan City, 71004, Taiwan
| | - Steve P Lee
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Hisu-Man Lin
- Department of Radiation Oncology, Chi Mei Medical Center, No.901, Jhonghua Rd., Yongkang Dist., Tainan City, 71004, Taiwan
| | - Hsiao-Yun Chen
- Department of Radiation Oncology, Chi Mei Medical Center, No.901, Jhonghua Rd., Yongkang Dist., Tainan City, 71004, Taiwan
| | - Chun-Chiao Huang
- Department of Radiation Oncology, Chi Mei Medical Center, No.901, Jhonghua Rd., Yongkang Dist., Tainan City, 71004, Taiwan
| | - Shih-Chang Wang
- Department of Radiation Oncology, Chi Mei Medical Center, No.901, Jhonghua Rd., Yongkang Dist., Tainan City, 71004, Taiwan
| | - Ching-Chieh Yang
- Department of Radiation Oncology, Chi Mei Medical Center, No.901, Jhonghua Rd., Yongkang Dist., Tainan City, 71004, Taiwan.,Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yu-Wei Lin
- Department of Radiation Oncology, Chi Mei Medical Center, No.901, Jhonghua Rd., Yongkang Dist., Tainan City, 71004, Taiwan. .,Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
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Nicosia L, Figlia V, Mazzola R, Napoli G, Giaj-Levra N, Ricchetti F, Rigo M, Lunardi G, Tomasini D, Bonù ML, Corradini S, Ruggieri R, Alongi F. Repeated stereotactic radiosurgery (SRS) using a non-coplanar mono-isocenter ( HyperArc™) technique versus upfront whole-brain radiotherapy (WBRT): a matched-pair analysis. Clin Exp Metastasis 2020; 37:77-83. [PMID: 31691873 DOI: 10.1007/s10585-019-10004-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/30/2019] [Indexed: 12/25/2022]
Abstract
Stereotactic radiosurgery (SRS) is an effective treatment option for multiple brain metastases (BMs). Modern mono-isocentric techniques allow the delivery of multiple stereotactic courses, in the event of intracranial failure. Nevertheless, limited data on effectiveness and toxicity have been reported in comparison to WBRT. Aim of this retrospective matched-pair analysis was to compare patients affected by limited BMs treated with multiple SRS courses using a mono-isocentric, non-coplanar technique (HyperArc™, Varian Medical System) to upfront WBRT. One hundred and two patients accounting for 677 BMs were treated with HyperArc™. In case of further intracranial progression, 44 treatment courses of 201 metastases in 19 patients, were treated by subsequent HyperArc™ courses. This population was matched with 38 patients treated with WBRT. The median BMs number was 4 (range 2-10) for HyperArc™ and 5 (range 2-10) for WBRT. Overall survival (OS) and toxicity were evaluated. The median follow-up was 9 months (range 3-40 months). The median OS was not reached (range 5-22 months) for HyperArc™ patients and 8 months (range 3-40 months) for WBRT patients, while the 1-year OS was 77% and 34.6% for HyperArc™ and WBRT, respectively (p = 0.001; HR 4.77, 95% CI 1.62-14.00). There was one case of radionecrosis. HyperArc™ is an effective and safe technique for the treatment of multiple BMs. In selected cases of intracranial oligorecurrence, further subsequent courses can be safely delivered with the same technical approach. Moreover, in patients with a limited number of BMs, SRS showed an improved survival outcome when compared to WBRT.
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Affiliation(s)
- Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Giuseppe Napoli
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Gianluigi Lunardi
- Medical Analysis Laboratory, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Davide Tomasini
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.,University of Brescia, Brescia, Italy
| | - Marco L Bonù
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.,University of Brescia, Brescia, Italy
| | - Stefanie Corradini
- Radiation Oncology Department, University Hospital, LMU Munich, Munich, Germany
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.,University of Brescia, Brescia, Italy
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Sagawa T, Ohira S, Ueda Y, Akino Y, Mizuno H, Matsumoto M, Miyazaki M, Koizumi M, Teshima T. Dosimetric effect of rotational setup errors in stereotactic radiosurgery with HyperArc for single and multiple brain metastases. J Appl Clin Med Phys 2019; 20:84-91. [PMID: 31507075 PMCID: PMC6806481 DOI: 10.1002/acm2.12716] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose In stereotactic radiosurgery (SRS) with single‐isocentric treatments for brain metastases, rotational setup errors may cause considerable dosimetric effects. We assessed the dosimetric effects on HyperArc plans for single and multiple metastases. Methods For 29 patients (1–8 brain metastases), HyperArc plans with a prescription dose of 20–24 Gy for a dose that covers 95% (D95%) of the planning target volume (PTV) were retrospectively generated (Ref‐plan). Subsequently, the computed tomography (CT) used for the Ref‐plan and cone‐beam CT acquired during treatments (Rot‐CT) were registered. The HyperArc plans involving rotational setup errors (Rot‐plan) were generated by re‐calculating doses based on the Rot‐CT. The dosimetric parameters between the two plans were compared. Results The dosimetric parameters [D99%, D95%, D1%, homogeneity index, and conformity index (CI)] for the single‐metastasis cases were comparable (P > 0.05), whereas the D95% for each PTV of the Rot‐plan decreased 10.8% on average, and the CI of the Rot‐plan was also significantly lower than that of the Ref‐plan (Ref‐plan vs Rot‐plan, 0.93 ± 0.02 vs 0.75 ± 0.14, P < 0.01) for the multiple‐metastases cases. In addition, for the multiple‐metastases cases, the Rot‐plan resulted in significantly higher V10Gy (P = 0.01), V12Gy (P = 0.02), V14Gy (P = 0.02), and V16Gy (P < 0.01) than those in the Ref‐plan. Conclusion The rotational setup errors for multiple brain metastases cases caused non‐negligible underdosage for PTV and significant increases of V10Gy to V16Gy in SRS with HyperArc.
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Affiliation(s)
- Tomohiro Sagawa
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuichi Akino
- Division of Medical Physics, Oncology Center, Osaka University Hospital, Suita, Japan
| | - Hirokazu Mizuno
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masao Matsumoto
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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Ohira S, Sagawa T, Ueda Y, Inui S, Masaoka A, Akino Y, Mizuno H, Miyazaki M, Koizumi M, Teshima T. Effect of collimator angle on HyperArc stereotactic radiosurgery planning for single and multiple brain metastases. Med Dosim 2019; 45:85-91. [PMID: 31378401 DOI: 10.1016/j.meddos.2019.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/07/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Abstract
We assessed the effect of collimator angle on the dosimetric parameters for targets and organs at risk (OARs) for collimator-optimized HA (CO-HA) and non-CO-HA (nCO-HA) plans. The nCO-HA and CO-HA plans were retrospectively generated for 26 patients (1 to 8 brain metastases). The dosimetric parameters for planning target volume (homogeneity index [HI]; conformity index [CI]; gradient index [GI]) and for OARs were compared. The modulation complexity score for volumetric modulated arc therapy (MCSV) and monitor units (MUs) were calculated. Doses were measured using the electronic portal imaging device and compared with the expected doses. Dosimetric parameters of the HI, CI, and GI for single (n = 12) and multiple (n = 14) metastases cases were comparable (p > 0.05). For multiple metastases cases, the CO-HA plan provided lower V4Gy, V12Gy, V14Gy, V16Gy for brain tissue compared to the nCO-HA plan (p < 0.05). Doses for OARs (D0.1cc) (brainstem, chiasm, Hippocampus, lens, optic nerves, and retinas) were comparable (p > 0.05). For multiple metastases cases, the CO-HA plan resulted in less complex multileaf collimator (MLC) patterns (MCSV = 0.19 ± 0.04, p < 0.01), lower MUs (8596 ± 1390 MUs, p < 0.01), and shorter beam-on time (6.2 ± 1.0 min, p < 0.01) compared to the nCO-HA plan (0.16 ± 0.04, 9365 ± 1630, and 6.7 ± 1.2 for MCSV, MUs, and beam-on time, respectively). For both treatment approach, the equivalent gamma passing rate was obtained with the 3%/3 mm and 2%/2 mm criteria (p > 0.05). The collimator optimization in the HA planning reduced doses to brain tissues and improved the treatment efficacy.
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Affiliation(s)
- Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan; Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Tomohiro Sagawa
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shoki Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Masaoka
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuichi Akino
- Division of Medical Physics, Oncology Center, Osaka University Hospital, Suita, Japan
| | - Hirokazu Mizuno
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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Alongi F, Fiorentino A, Gregucci F, Corradini S, Giaj-Levra N, Romano L, Rigo M, Ricchetti F, Beltramello A, Lunardi G, Mazzola R, Ruggieri R. First experience and clinical results using a new non-coplanar mono-isocenter technique ( HyperArc™) for Linac-based VMAT radiosurgery in brain metastases. J Cancer Res Clin Oncol 2019; 145:193-200. [PMID: 30382369 DOI: 10.1007/s00432-018-2781-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/24/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Radiosurgery (SRS) or stereotactic fractionated radiotherapy (SFRT) is increasing in the treatment of brain metastases (BMs). Aim of the present study was to evaluate the safety and effectiveness of SRS/SFRT for BMs, using a new mono-isocenter non-coplanar solution (HyperArc™ Varian Medical System). METHODS BMs patients with a diameter inferior to 3 cm, a life expectancy of more than 3 months and a good performance status, were eligible for Linac-based volumetric modulated arc therapy (VMAT) SFRT/SRS with HyperArc™. A retrospective analysis of patients and BMs was performed. RESULTS From August 2017 to May 2018, 381 BMs in 64 patients were treated and 246 BMs (43 patients, median number of BMs: 5) of them were suitable for analysis. With a median FU time of 6 months, 244 out 246 (99%) BMs were controlled (18% complete response; 41% partial response, 40% stable disease), 2 BMs showed a progression, at the first control. No acute or late toxicities were reported. Median overall survival (OS) has not yet been achieved, while median time to progression was 5 months. In univariate analysis, statistically negative prognostic factors for OS were histology of primary tumor (p = 0.009): lung/breast cancer had better survival rates as compared to others. Cumulative intracranial volume disease ≥ 15 cc and systemic progression disease were independent prognostic factors for OS at univariate (p = 0.04; p = 0.005) and multivariate (p = 0.04; p = 0.009) analysis, respectively. CONCLUSION The present first clinical data show that SFRT/SRS with HyperArc™ is safe and effective for BMs patients. The utilization of SFRT/SRS for BMs is promising and should be further explored in randomized trials.
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Slosarek K, Bekman B, Wendykier J, Grządziel A, Fogliata A, Cozzi L. In silico assessment of the dosimetric quality of a novel, automated radiation treatment planning strategy for linac-based radiosurgery of multiple brain metastases and a comparison with robotic methods. Radiat Oncol 2018; 13:41. [PMID: 29544504 PMCID: PMC5856310 DOI: 10.1186/s13014-018-0997-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background To appraise the dosimetric features and the quality of the treatment plan for radiosurgery of multiple brain metastases optimized with a novel automated engine and to compare with plans optimized for robotic-based delivery. Methods A set of 15 patients with multiple brain metastases was selected for this in silico study. The technique under investigation is the recently introduced HyperArc. For all patients, three treatment plans were computed and compared: i: a HyperArc; ii: a standard VMAT; iii) a CyberKnife. Dosimetric features were computed for the clinical target volumes as well as for the healthy brain tissue and the organs at risk. Results The data showed that the best dose homogeneity was achieved with the VMAT technique. HyperArc allowed to minimize the volume of brain receiving 4Gy (as well as for the mean dose and the volume receiving 12Gy, although not statistically significant). The smallest dose on 1 cm3 volume for all organs at risk is for CK techniques, and the biggest for VMAT (p < 0.05). The Radiation Planning Index coefficient indicates that, there are no significant differences among the techniques investigated, suggesting an equivalence among these. Conclusion At treatment planning level, the study demonstrates that the use of HyperArc technique can significantly improve the sparing of the healthy brain while maintaining a full coverage of the target volumes.
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Affiliation(s)
- Krzysztof Slosarek
- Department of Radiotherapy Planning, Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Barbara Bekman
- Department of Radiotherapy Planning, Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Jacek Wendykier
- Department of Radiotherapy Planning, Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Aleksandra Grządziel
- Department of Radiotherapy Planning, Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland.,Department of Medical Physics, University of Silesia, Katowice, Poland
| | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy. .,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
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Ruggieri R, Naccarato S, Mazzola R, Ricchetti F, Corradini S, Fiorentino A, Alongi F. Linac-based VMAT radiosurgery for multiple brain lesions: comparison between a conventional multi-isocenter approach and a new dedicated mono-isocenter technique. Radiat Oncol 2018; 13:38. [PMID: 29506539 DOI: 10.1186/s13014-018-0985-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 02/26/2018] [Indexed: 12/14/2022] Open
Abstract
Background Linac-based stereotactic radiosurgery or fractionated stereotactic radiotherapy (SRS/FSRT) of multiple brain lesions using volumetric modulated arc therapy (VMAT) is typically performed by a multiple-isocenter approach, i.e. one isocenter per lesion, which is time-demanding for the need of independent setup verifications of each isocenter. Here, we present our initial experience with a new dedicated mono-isocenter technique with multiple non-coplanar arcs (HyperArc™, Varian Inc.) in terms of a plan comparison with a multiple-isocenter VMAT approach. Methods From August 2017 to October 2017, 20 patients with multiple brain metastases (mean 5, range 2–10) have been treated by HyperArc in 1–3 fractions. The prescribed doses (Dp) were 18–25 Gy in single-fraction, and 21–27 Gy in three-fractions. Planning Target Volume (PTV), defined by a 2 mm isotropic margin from each lesion, had mean dimension of 9.6 cm3 (range 0.5–27.9 cm3). Mono-isocenter HyperArc VMAT plans (HA) with 5 non-coplanar 180°-arcs (couch at 0°, ±45°, ±90°) were generated and compared to multiple-isocenter VMAT plans (RA) with 2 coplanar 360°-arcs per isocenter. A dose normalization of 100%Dp at 98%PTV was adopted, while D2%(PTV) < 150%Dp was accepted. All plans had to respect the constraints on maximum dose to the brainstem (D0.5cm3 < 18 Gy) as well as to the optical nerves/chiasm, eyes and lenses (D0.5cm3 < 15 Gy). HA and RA plans were compared in terms of dose-volume metrics, by Paddick conformity (CI) and gradient (GI) index and by V12 and mean dose to the brain-minus-PTV, and in terms of MU and overall treatment time (OTT) per fraction. OTT was measured for HA treatments, whereas for RA plans OTT was estimated by assuming 3 min. For initial patient setup plus 5 min. For each CBCT-guided setup correction per isocenter. Results Significant variations in favour of HA plans were computed for both target dose indexes, CI (p < .01) and GI (p < .01). The lower GI in HA plans was the likely cause of the significant reduction in V12 to the brain-minus-PTV (p = .023). Although at low doses, below 2–5 Gy, the sparing of the brain-minus-PTV was in favour of RA plans, no significant difference in terms of mean doses to the brain-minus-PTV was observed between the two groups (p = .31). Finally, both MU (p < .01) and OTT (p < .01) were significantly reduced by HyperArc plans. Conclusions For linac-based SRS/FSRT of multiple brain lesions, HyperArc plans assured a higher CI and a lower GI than standard multiple-isocenter VMAT plans. This is consistent with the computed reduction in V12 to the brain-minus-PTV. Finally, HyperArc treatments were completed within a typical 20 min. time slot, with a significant time reduction with respect to the expected duration of multiple-isocenters VMAT.
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Ohira S, Ueda Y, Akino Y, Hashimoto M, Masaoka A, Hirata T, Miyazaki M, Koizumi M, Teshima T. HyperArc VMAT planning for single and multiple brain metastases stereotactic radiosurgery: a new treatment planning approach. Radiat Oncol 2018; 13:13. [PMID: 29378610 PMCID: PMC5789615 DOI: 10.1186/s13014-017-0948-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
Purpose The HyperArc VMAT (HA-VMAT) planning approach was newly developed to fulfill the demands of dose delivery for brain metastases stereotactic radiosurgery. We compared the dosimetric parameters of the HA-VMAT plan with those of the conventional VMAT (C-VMAT). Material and methods For 23 patients (1–4 brain metastases), C-VMAT and HA-VMAT plans with a prescription dose of 20–24 Gy were retrospectively generated, and dosimetric parameters for PTV (homogeneity index, HI; conformity index, CI; gradient index, GI) and brain tissue (V2Gy-V16Gy) were evaluated. Subsequently, the physical characteristics (modulation complexity score for VMAT, MCSV; Monitor unit, MU) of both treatment approaches were compared. Results HA-VMAT provided higher HI (1.41 ± 0.07 vs. 1.24 ± 0.07, p < 0.01), CI (0.93 ± 0.02 vs. 0.90 ± 0.05, p = 0.01) and lower GI (3.06 ± 0.42 vs. 3.91 ± 0.55, p < 0.01) values. Moderate-to-low dose spreads (V4Gy-V16Gy) were significantly reduced (p < 0.01) in the HA-VMAT plan over that of C-VMAT. HA-VMAT plans resulted in more complex MLC patterns (lower MCSV, p < 0.01) and higher MU (p < 0.01). Conclusions HA-VMAT plans provided significantly higher conformity and rapid dose falloff with respect to the C-VMAT plans.
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Affiliation(s)
- Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan.,Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Yuichi Akino
- Division of Medical Physics, Oncology Center, Osaka University Hospital, 2-2 (D10) Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Misaki Hashimoto
- Department of Radiation Oncology, Yao Municipal Hospital, 1-3-1 Ryuge-cho, Yao, Osaka, 581-0069, Japan
| | - Akira Masaoka
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Takero Hirata
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan.
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