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Ma M, Ren W, Li M, Niu C, Dai J. Dosimetric comparison of coplanar and noncoplanar beam arrangements for radiotherapy of patients with lung cancer: A meta-analysis. J Appl Clin Med Phys 2021; 22:34-43. [PMID: 33634946 PMCID: PMC8035566 DOI: 10.1002/acm2.13197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Radiotherapy plays an important role in the treatment of lung cancer, and both coplanar beam arrangements (CBA) and noncoplanar beam arrangements (NCBA) are adopted in clinic practice. The aim of this study is to answer the question whether NCBA are dosimetrically superior to CBA. Methods Search of publications were performed in PubMed, Web of Science, and the Cochran Library till March 2020. The searching terms were as following: ((noncoplanar) or ("non coplanar") or ("4pi") or ("4π")) AND (("lung cancer") or ("lung tumor") or ("lung carcinoma")) AND ((radiotherapy) or ("radiation therapy")). The included studies and extracted data were manually screened. All forest and funnel plots were carried out with RevMan software, and the Egger’s regression asymmetry tests were conducted with STATA software. Results Nine studies were included and evaluated in the meta‐analysis and treatment plans were designed with both CBA and NCBA. For the planning target volumes (PTV), D98%, D2%, the conformity index (CI), and the gradient index (GI) had no statistically significant difference. For organs‐at‐risk (OAR), V20 of the whole lung and the maximum dose of the spinal cord were significantly reduced in NCBA plans compared with CBA ones. But V10, V5, and mean dose of the whole lung, the maximum dose of the heart, and the maximum dose of the esophagus exhibited no significant difference when the two types of beam arrangements were compared. Conclusion After combining multicenter results, NCBA plans have significant advantages in reducing V20 of the whole lung and max dose of spinal cord.
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Affiliation(s)
- Min Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenting Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minghui Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuanmeng Niu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianrong Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yiga T, Lin TG, Williamson B, Lenards N, Hunzeker A, Tobler M, Zeiler S, Fellows A. A case study of evaluating bilateral lung dose for VMAT treatment planning using a partial sagittal arc. Med Dosim 2021; 46:236-239. [PMID: 33478797 DOI: 10.1016/j.meddos.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
Radiation pneumonitis (RP) is a potential toxic side effect of thoracic radiotherapy. Optimal planning techniques must maintain tumor coverage while limiting dose to normal lung tissue to reduce the risk of patients developing RP. The addition of a noncoplanar arc may be beneficial by increasing treatment angles and providing an ideal dose distribution for tumor coverage while decreasing dose to organs at risk (OAR). The purpose of this research was to compare the effects on the normal bilateral lung tissue receiving 20 Gy, 10 Gy and 5 Gy (V20, V10, V5) and the mean lung dose (MLD) values when medial lung tumors are treated with 3 partial coplanar arcs vs 2 partial coplanar arcs combined with a partial sagittal arc. Researchers hypothesized that a beam arrangement of 2 partial coplanar arcs and 1 partial sagittal arc would reduce V20, V10, V5, and MLD values when compared to a 3 partial coplanar arc plan. In a retrospective study of 5 patients with bulky, medial right lung lesions without nodal involvement, cases were planned with both a noncoplanar and a coplanar arc geometry. Results were evaluated using a two-tailed t-test to determine the statistical significance (p < 0.05) of changes to total lung volume analyzation metrics when a noncoplanar sagittal arc was incorporated compared to the standard lung treatment using only coplanar arcs. Although some patient cases showed minor improvement in the V20, V10, V5, and MLD metrics, the study results were not statistically significant and showed no advantage with the introduction of an anterior sagittal arc over a coplanar beam arrangement.
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Affiliation(s)
- Tenzin Yiga
- University of Wisconsin, La Crosse, WI 54601, USA
| | | | | | | | | | - Matt Tobler
- University of Wisconsin, La Crosse, WI 54601, USA
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Vander Veken L, Dechambre D, Michiels S, Cohilis M, Souris K, Lee JA, Geets X. Improvement of kilovoltage intrafraction monitoring accuracy through gantry angles selection. Biomed Phys Eng Express 2020; 6. [PMID: 35073540 DOI: 10.1088/2057-1976/abb18e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/21/2020] [Indexed: 11/11/2022]
Abstract
Kilovoltage intrafraction monitoring (KIM) is a method allowing to precisely infer the tumour trajectory based on cone beam computed tomography (CBCT) 2D-projections. However, its accuracy is deteriorated in the case of highly mobile tumours involving hysteresis. A first adaptation of KIM consisting of a prior amplitude based binning step has been developed in order to minimize the errors of the original model (phase-KIM). In this work, we propose enhanced methods (KIMsub-arc optimand phase-KIMsub-arc optim) to improve the accuracy of KIM and phase-KIM which relies on the selection of the optimal starting CBCT gantry angle. Aiming at demonstrating the interest of our approach, we carried out a simulation study and an experimental study: we compared the accuracy of the conventional versus sub-arc optim methods on simulated realistic tumour motions with amplitudes ranging from 5 to 30 mm in 1 mm increments. The same approach was performed using a lung dynamic phantom generating a 30 mm amplitude sinusoidal motion. The results show that for in-silico simulated motions of 10, 20 and 30 mm amplitude, the three-dimensional root mean square error (3D-RMSE) can be reduced by 0.67 mm, 0.91 mm, 0.94 mm and 0.18 mm, 0.25 mm, 0.28 mm using KIMsub-arc optimand phase-KIMsub-arc optimrespectively. Considering all in-silico simulated trajectories, the percentage of errors larger than 1 mm decreases from 21.9% down to 1.6% for KIM (p < 0.001) and from 6.6% down to 1.2% for phase-KIM (p < 0.001). Experimentally, the 3D-RMSE is lowered by 0.5732 mm for KIM and by 0.1 mm for phase-KIM. The percentage of errors larger than 1 mm falls from 39.7% down to 18.5% for KIM and from 23.2% down to 11.1% for phase-KIM. In conclusion, our method efficiently anticipates CBCT gantry angles associated with a significantly better accuracy by using KIM and phase-KIM.
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Affiliation(s)
- Loïc Vander Veken
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium
| | - David Dechambre
- Radiotherapy Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Steven Michiels
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium.,Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Marie Cohilis
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium.,Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Kevin Souris
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium.,Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - John Aldo Lee
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Xavier Geets
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium.,Radiotherapy Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
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Kim ST, An HJ, Kim JI, Yoo JR, Kim HJ, Park JM. Non-coplanar VMAT plans for lung SABR to reduce dose to the heart: a planning study. Br J Radiol 2019; 93:20190596. [PMID: 31625759 DOI: 10.1259/bjr.20190596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to compare the plan quality of non-coplanar partial arc (NPA) volumetric modulated arc therapy (VMAT) to that of coplanar partial arc (CPA) VMAT for stereotactic ablative radiotherapy (SABR) for lung cancer. METHODS A total of 20 patients treated for lung cancer with the SABR VMAT technique and whose lung tumors were close to the heart were retrospectively selected for this study. For the CPA VMAT, three coplanar half arcs were used while two coplanar half arcs and one noncoplanar arc rotating 315°-45° with couch rotations of 315° ± 5° were used for the NPA VMAT. For each patient, identical CT image sets and identical structures were used for both the CPA and NPA VMAT plans. Dose-volumetric parameters of each plan were analyzed. RESULTS For the planning target volume and both lungs, no statistically significant differences between the CPA and NPA VMAT plans were observed in general. For the heart, average values of D0.1cc of the CPA and NPA VMAT plans were 29.42 ± 13.37 and 21.71 ± 9.20 Gy, respectively (p < 0.001). For whole body, the mean dose and the gradient index of the CPA VMAT plans were 1.2 ± 0.5 Gy and 4.356 ± 0.608 while those of the NPA VMAT plans were 1.1 ± 0.5 Gy and 4.111 ± 0.480, respectively (both with p < 0.001). CONCLUSION The NPA VMAT proposed in this study showed more favorable plan quality than the CPA VMAT plans for lung SABR with tumors located close to the heart. ADVANCES IN KNOWLEDGE For lung SABR, NPA VMAT can reduce doses to the heart as well as whole-body irradiation.
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Affiliation(s)
- Sang-Tae Kim
- Nuclear Emergency Division, Radiation Protection and Emergency Preparedness Bureau, Nuclear Safety and Security Commission, Seoul, Korea
| | - Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Biomedical Sciences, Seoul National University, Seoul, Korea
| | - Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jae-Ryong Yoo
- Radiation Emergency Medicine Regulation Team, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Robotics Research Laboratory for Extreme Environments, Advanced Institute of Convergence Technology, Suwon, Korea
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Barrett S, Thirion P, Harper D, Simpkin AJ, Leech M, Hickey K, Ryan L, Marignol L. Dosimetric impact of uncorrected systematic yaw rotation in VMAT for peripheral lung SABR. Rep Pract Oncol Radiother 2019; 24:520-527. [PMID: 31516398 DOI: 10.1016/j.rpor.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/02/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022] Open
Abstract
Aim This study aimed to evaluate the dosimetric impact of uncorrected yaw rotational error on both target coverage and OAR dose metrics in this patient population. Background Rotational set up errors can be difficult to correct in lung VMAT SABR treatments, and may lead to a change in planned dose distributions. Materials and methods We retrospectively applied systematic yaw rotational errors in 1° degree increments up to -5° and +5° degrees in 16 VMAT SABR plans. The impact on PTV and OARs (oesophagus, spinal canal, heart, airway, chest wall, brachial plexus, lung) was evaluated using a variety of dose metrics. Changes were assessed in relation to percentage deviation from approved planned dose at 0 degrees. Results Target coverage was largely unaffected with the largest mean and maximum percentage difference being 1.4% and 6% respectively to PTV D98% at +5 degrees yaw.Impact on OARs was varied. Minimal impact was observed in oesophagus, spinal canal, chest wall or lung dose metrics. Larger variations were observed in the heart, airway and brachial plexus. The largest mean and maximum percentage differences being 20.77% and 311% respectively at -5 degrees yaw to airway D0.1cc, however, the clinical impact was negligible as these variations were observed in metrics with minimal initial doses. Conclusions No clinically unacceptable changes to dose metrics were observed in this patient cohort but large percentage deviations from approved dose metrics in OARs were noted. OARs with associated PRV structures appear more robust to uncorrected rotational error.
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Affiliation(s)
- Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
| | | | - Dean Harper
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Andrew J Simpkin
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
| | - Kim Hickey
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Laoise Ryan
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Laure Marignol
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
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Rijken J, Kairn T, Crowe S, Trapp J. Effect of arc length on skin dose from hypofractionated volumetric modulated arc radiotherapy treatments of the lung and spine. Med Dosim 2019; 44:309-314. [DOI: 10.1016/j.meddos.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023]
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Lo SS, Foote M, Siva S, Slotman BJ, Teh BS, Guckenberger M, Tan D, Mayr NA, Sahgal A. Technical know-how in stereotactic ablative radiotherapy (SABR). J Med Radiat Sci 2016; 63:5-8. [PMID: 27087969 PMCID: PMC4775826 DOI: 10.1002/jmrs.163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 11/20/2022] Open
Abstract
Stereotactic ablative radiotherapy (SABR) is an addition to the armamentarium against cancer. The technical requirements for SABR are very stringent, given its very narrow therapeutic window. However, when the principles are strictly followed, it is possible to deliver SABR to extracranial tumours safely and effectively.![]()
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Affiliation(s)
- Simon S Lo
- Department of Radiation Oncology University Hospitals Seidman Cancer Center Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Matthew Foote
- Department of Radiation Oncology Princess Alexandra Hospital School of Medicine University of Queensland Queensland Australia
| | - Shankar Siva
- Division of Radiation Oncology Peter MacCallum Cancer Centre East Melbourne Victoria Australia
| | - Ben J Slotman
- Department of Radiation Oncology VU University Medical Center Amsterdam Netherlands
| | - Bin S Teh
- Department of Radiation Oncology Houston Methodist Hospital Weill Cornell Medical College Houston Texas USA
| | | | - Daniel Tan
- Asian American Radiation Oncology Singapore
| | - Nina A Mayr
- Department of Radiation Oncology University of Washington Seattle Washington USA
| | - Arjun Sahgal
- Department of Radiation Oncology Sunnybrook Health Sciences Center University of Toronto Toronto Ontario Canada
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Fitzgerald R, Owen R, Hargrave C, Pryor D, Barry T, Lehman M, Bernard A, Mai T, Seshadri V, Fielding A. A comparison of three different VMAT techniques for the delivery of lung stereotactic ablative radiation therapy. J Med Radiat Sci 2016; 63:23-30. [PMID: 27087972 PMCID: PMC4775834 DOI: 10.1002/jmrs.156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/20/2015] [Accepted: 12/13/2015] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The purpose of this study was to investigate coplanar and non-coplanar volumetric modulated arc therapy (VMAT) delivery techniques for stereotactic ablative radiation therapy (SABR) to the lung. METHODS For ten patients who had already completed a course of radiation therapy for early stage lung cancer, three new SABR treatment plans were created using (1) a coplanar full arc (FA) technique, (2) a coplanar partial arc technique (PA) and (3) a non-coplanar technique utilising three partial arcs (NCA). These plans were evaluated using planning target volume (PTV) coverage, dose to organs at risk, and high and intermediate dose constraints as incorporated by radiation therapy oncology group (RTOG) 1021. RESULTS When the FA and PA techniques were compared to the NCA technique, on average the PTV coverage (V 54Gy) was similar (P = 0.15); FA (95.1%), PA (95.11%) and NCA (95.71%). The NCA resulted in a better conformity index (CI) of the prescription dose (0.89) when compared to the FA technique (0.88, P = 0.23) and the PA technique (0.83, P = 0.06). The NCA technique improved the intermediate dose constraints with a statistically significant difference for the D 2cm and R 50% when compared with the FA (P < 0.03 and <0.0001) and PA (P < 0.04 and <0.0001) techniques. The NCA technique reduced the maximum spinal cord dose by 2.72 and 4.2 Gy when compared to the PA and FA techniques respectively. Mean lung doses were 4.09, 4.31 and 3.98 Gy for the FA, PA and NCA techniques respectively. CONCLUSION The NCA VMAT technique provided the highest compliance to RTOG 1021 when compared to coplanar techniques for lung SABR. However, single FA coplanar VMAT was suitable for 70% of patients when minor deviations to both the intermediate dose and organ at risk (OAR) constraints were accepted.
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Affiliation(s)
- Rhys Fitzgerald
- Radiation Oncology CentresMater Private HospitalSpringfieldQueenslandAustralia
- Science and Engineering FacultyQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Rebecca Owen
- Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Catriona Hargrave
- Division of Radiation TherapyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
- Radiation Oncology Mater CentreSouth BrisbaneQueenslandAustralia
| | - David Pryor
- Department of Radiation OncologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - Tamara Barry
- Division of Radiation TherapyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - Margot Lehman
- Department of Radiation OncologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - Anne Bernard
- QFAB BioinformaticsInstitute for Molecular BioscienceUniversity of QueenslandQueenslandAustralia
| | - Tao Mai
- Department of Radiation OncologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | | | - Andrew Fielding
- Science and Engineering FacultyQueensland University of TechnologyBrisbaneQueenslandAustralia
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