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Panda S, Swamidas J, Chopra S, Mangaj A, Fogliata A, Kupelian P, Agarwal JP, Cozzi L. Treatment planning comparison of volumetric modulated arc therapy employing a dual-layer stacked multi-leaf collimator and helical tomotherapy for cervix uteri. Radiat Oncol 2020; 15:22. [PMID: 32000832 PMCID: PMC6990476 DOI: 10.1186/s13014-020-1473-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/19/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To ascertain the dosimetric performance of a new delivery system (the Halcyon system, H) equipped with dual-layer stacked multi-leaf collimator (MLC) for risk-adapted targets in cervix uteri cancer patients compared to another ring-based system in clinical operation (Helical Tomotherapy, HT). Methods Twenty patients were retrospectively included in a treatment planning study (10 with positive lymph nodes and 10 without). The dose prescription (45Gy to the primary tumour volume and a simultaneously integrated boost up to 55Gy for the positive patients) and the clinical planning objectives were defined consistently as recommended by an ongoing multicentric clinical trial. Halcyon plans were optimised for the volumetric modulated arc therapy. The plan comparison was performed employing the quantitative analysis of the dose-volume histograms. Results The coverage of the primary and nodal target volumes was comparable for both techniques and both subsets of patients. The primary planning target volume (PTV) receiving at least 95% of the prescription isodose ranged from 97.2 ± 1.1% (node-negative) to 99.1 ± 1.2% (node-positive) for H and from 96.5 ± 1.9% (node-negative) to 98.3 ± 0.9% (node-positive) for HT. The uncertainty is expressed at one standard deviation from the cohort of patient per each group. For the nodal clinical target volumes, the dose received by 98% of the planning target volume ranged 55.5 ± 0.1 to 56.0 ± 0.8Gy for H and HT, respectively. The only significant and potentially relevant differences were observed for the bowels. In this case, V40Gy resulted 226.3 ± 35.9 and 186.9 ± 115.9 cm3 for the node-positive and node-negative patients respectively for Halcyon. The corresponding findings for HT were: 258.9 ± 60.5 and 224.9 ± 102.2 cm3. On the contrary, V15Gy resulted 1279.7 ± 296.5 and 1557.2 ± 359.9 cm3 for HT and H respectively for node-positive and 1010.8 ± 320.9 versus 1203.8 ± 332.8 cm3 for node-negative. Conclusion This retrospective treatment planning study, based on the dose constraints derived from the Embrace II study protocol, suggested the essential equivalence between Halcyon based and Helical Tomotherapy based plans for the intensity-modulated rotational treatment of cervix uteri cancer. Different levels of sparing were observed for the bowels with H better protecting in the high-dose region and HT in the mid-low dose regions. The clinical impact of these differences should be further addressed.
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Affiliation(s)
- S Panda
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - J Swamidas
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - S Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - A Mangaj
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - A Fogliata
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - P Kupelian
- Varian Medical Systems, Palo Alto, CA, USA.,Radiation Oncology Dept., University of California, Los Angeles, USA
| | - J P Agarwal
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - L Cozzi
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy. .,Dept. of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy.
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Cozzi L, Fogliata A, Thompson S, Franzese C, Franceschini D, de Rose F, Tomatis S, Scorsetti M. Critical Appraisal of the Treatment Planning Performance of Volumetric Modulated Arc Therapy by Means of a Dual Layer Stacked Multileaf Collimator for Head and Neck, Breast, and Prostate. Technol Cancer Res Treat 2019; 17:1533033818803882. [PMID: 30295172 PMCID: PMC6176542 DOI: 10.1177/1533033818803882] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: To ascertain whether a new delivery system (the Halcyon system) equipped with
dual-layer stacked multileaf collimator operating in a mode, which allows
independent, fully interdigitating motion of both layers and 6 flattening
filter free energy, could generate plans of high clinical quality compared
to a well-established delivery system with single layer multileaf
collimator. Methods: Twenty patients in each of the 3 groups (advanced head and neck, breast, and
high-risk prostate) were selected for an in silico planning study. For each
patient, reference plans were developed for volumetric modulated arc therapy
technique with 6 MV photon beams from a TrueBeam linear accelerator and
compared against the corresponding plans for the Halcyon system. Plan
comparison was performed in terms of dose volume histogram quantitative
analysis. Results: Concerning the planning target volumes, with identical dose calculation and
optimization algorithms and with identical planning techniques, no
clinically relevant difference in coverage (D98%), hot spot
(D2%), or homogeneity was observed. Similarly, for all the
organs at risk, the dosimetric findings showed that (1) all planning
constraints were met by the 2 delivery systems and (2) although statistical
significant differences were reported for most of the parameters but none of
these were judged of potential clinical relevance. Conclusion: The data presented confirmed that the new delivery system can generate
treatment plans for volumetric modulated arc therapy with the same
dosimetric quality of what is achievable with other systems routinely used
in the clinics without significantly changing the current practice.
Additional studies which customize the optimization parameters for each
delivery device would complement the spectrum of investigations.
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Affiliation(s)
- Luca Cozzi
- 1 Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan-Rozzano, Italy.,2 Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| | - Antonella Fogliata
- 1 Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan-Rozzano, Italy
| | | | - Ciro Franzese
- 1 Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan-Rozzano, Italy
| | - Davide Franceschini
- 1 Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan-Rozzano, Italy
| | - Fiorenza de Rose
- 1 Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan-Rozzano, Italy
| | - Stefano Tomatis
- 1 Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan-Rozzano, Italy
| | - Marta Scorsetti
- 1 Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan-Rozzano, Italy.,2 Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
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