1
|
Ding Y, Feng H, Yang Y, Holmes J, Liu Z, Liu D, Wong WW, Yu NY, Sio TT, Schild SE, Li B, Liu W. Deep-learning based fast and accurate 3D CT deformable image registration in lung cancer. Med Phys 2023; 50:6864-6880. [PMID: 37289193 PMCID: PMC10704004 DOI: 10.1002/mp.16548] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Deformable Image Registration (DIR) is an essential technique required in many applications of radiation oncology. However, conventional DIR approaches typically take several minutes to register one pair of 3D CT images and the resulting deformable vector fields (DVFs) are only specific to the pair of images used, making it less appealing for clinical application. PURPOSE A deep-learning-based DIR method using CT images is proposed for lung cancer patients to address the common drawbacks of the conventional DIR approaches and in turn can accelerate the speed of related applications, such as contour propagation, dose deformation, adaptive radiotherapy (ART), etc. METHODS: A deep neural network based on VoxelMorph was developed to generate DVFs using CT images collected from 114 lung cancer patients. Two models were trained with the weighted mean absolute error (wMAE) loss and structural similarity index matrix (SSIM) loss (optional) (i.e., the MAE model and the M+S model). In total, 192 pairs of initial CT (iCT) and verification CT (vCT) were included as a training dataset and the other independent 10 pairs of CTs were included as a testing dataset. The vCTs usually were taken 2 weeks after the iCTs. The synthetic CTs (sCTs) were generated by warping the vCTs according to the DVFs generated by the pre-trained model. The image quality of the synthetic CTs was evaluated by measuring the similarity between the iCTs and the sCTs generated by the proposed methods and the conventional DIR approaches, respectively. Per-voxel absolute CT-number-difference volume histogram (CDVH) and MAE were used as the evaluation metrics. The time to generate the sCTs was also recorded and compared quantitatively. Contours were propagated using the derived DVFs and evaluated with SSIM. Forward dose calculations were done on the sCTs and the corresponding iCTs. Dose volume histograms (DVHs) were generated based on dose distributions on both iCTs and sCTs generated by two models, respectively. The clinically relevant DVH indices were derived for comparison. The resulted dose distributions were also compared using 3D Gamma analysis with thresholds of 3 mm/3%/10% and 2 mm/2%/10%, respectively. RESULTS The two models (wMAE and M+S) achieved a speed of 263.7±163 / 265.8±190 ms and a MAE of 13.15±3.8 / 17.52±5.8 HU for the testing dataset, respectively. The average SSIM scores of 0.987±0.006 and 0.988±0.004 were achieved by the two proposed models, respectively. For both models, CDVH of a typical patient showed that less than 5% of the voxels had a per-voxel absolute CT-number-difference larger than 55 HU. The dose distribution calculated based on a typical sCT showed differences of ≤2cGy[RBE] for clinical target volume (CTV) D95 and D5 , within ±0.06% for total lung V5 , ≤1.5cGy[RBE] for heart and esophagus Dmean , and ≤6cGy[RBE] for cord Dmax compared to the dose distribution calculated based on the iCT. The good average 3D Gamma passing rates (> 96% for 3 mm/3%/10% and > 94% for 2 mm/2%/10%, respectively) were also observed. CONCLUSION A deep neural network-based DIR approach was proposed and has been shown to be reasonably accurate and efficient to register the initial CTs and verification CTs in lung cancer.
Collapse
Affiliation(s)
- Yuzhen Ding
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Hongying Feng
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Yunze Yang
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Jason Holmes
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Zhengliang Liu
- Department of Computer Science, University of Georgia, Athens, GA 30602, USA
| | - David Liu
- Athens Academy, Athens, GA 30602, USA
| | - William W. Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Nathan Y. Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Terence T. Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Baoxin Li
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, Arizona, USA 85281
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| |
Collapse
|
2
|
Mark F, Alnsour A, Penfold SN, Esterman A, Keys R, Le H. Volumetric modulated arc therapy (VMAT) comparison to 3D-conformal technique in lung stereotactic ablative radiotherapy (SABR). J Med Radiat Sci 2023; 70:72-80. [PMID: 36424510 PMCID: PMC9977664 DOI: 10.1002/jmrs.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Stereotactic ablative radiotherapy (SABR) can be a curative option for non-small cell lung cancer (NSCLC) and oligometastatic lung disease. Volumetric modulated arc therapy (VMAT) has offered further advancements in terms of radiation dose shaping without compromising treatment times however there is potential for greater low-dose exposure to the lung. This study was to assess whether VMAT lung SABR would result in any increase to the dosimetry parameters compared with three-dimensional conformal radiotherapy (3D-CRT) that could confer increased risk of radiation pneumonitis. METHODS A total of 53 and 30 3D-CRT treatment plans of patients treated with 48 Gy in 4 fractions were compared. RESULTS No statistically significant difference in planning target volumes between the VMAT 29.9 cc (range 12.4-58.5 cc) and 3D-CRT 31.2 cc (range 12.3-58.3 cc) P = 0.79. The mean of total lung V5, ipsilateral lung V5 and contralateral lung V5 all showed a trend of being smaller in the VMAT treatment group- 14% versus 15.8%, 25.6% versus 30.4% and 1.6% versus 2.2%, respectively, but all were not statistically significant differences. Mean of the mean lung dose MLD, again showed a trend of being lower in the VMAT treatments but was also non-significant, 2.6 Gy versus 3.0 Gy, P = 1.0. Mean V20 was the same in both cohorts, 3.3%. CONCLUSIONS The dosimetry for 3D-CRT and VMAT plans were not significantly different including V5, and therefore we conclude that VMAT treatment is unlikely to be associated with an increased risk of radiation pneumonitis.
Collapse
Affiliation(s)
- Frances Mark
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Oncology DepartmentPlymouth Hospitals TrustPlymouthUK
| | | | - Scott N. Penfold
- Australian Bragg Centre for Proton Therapy and ResearchAdelaideSouth AustraliaAustralia,Department of PhysicsUniversity of AdelaideAdelaideSouth AustraliaAustralia,SAHMRIAdelaideSouth AustraliaAustralia
| | - Adrian Esterman
- Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Robert Keys
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Hien Le
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Australian Bragg Centre for Proton Therapy and ResearchAdelaideSouth AustraliaAustralia,Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| |
Collapse
|
3
|
Lung SBRT treatment planning: a study of VMAT arc selection guided by collision check software. Med Dosim 2023; 48:82-89. [PMID: 36750392 DOI: 10.1016/j.meddos.2023.01.003] [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: 07/08/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023]
Abstract
To evaluate the effects of arc geometry on lung stereotactic body radiation therapy (SBRT) plan quality, using collision check software to select safe beam angles. Thirty lung SBRT cases were replanned 10Gy x 5 using 4 volumetric modulated arc therapy (VMAT) geometries: coplanar lateral (cpLAT), coplanar oblique (cpOBL), noncoplanar lateral (ncpLAT) and noncoplanar oblique (ncpOBL). Lateral arcs spanned 180° on the affected side whereas the 180° oblique arcs crossed midline to spare healthy tissues. Couch angles were separated by 30° on noncoplanar plans. Clearance was verified with Radformation CollisionCheck software. Optimization objectives were the same across the four plans for each case. Planning target volume (PTV) coverage was set to 95% and then plans were evaluated for dose conformity, healthy tissue doses, and monitor units. Clinically treated plans were used to benchmark the results. The volumes of the 25%, 50% and 75% isodoses were smaller with noncoplanar than coplanar arcs. The volume of the 50% isodose line relative to the PTV (CI50%) was as follows: clinical 3.75±0.72, cpLAT 3.39 ± 0.37, cpOBL 3.36 ± 0.34, ncpLAT 3.02 ± 0.21 and ncpOBL 3.02 ± 0.22. The Wilcoxon signed rank test with Bonferroni correction showed p < 0.005 in all CI50% comparisons except between the cpLat and cpObl arcs and between the ncpLat and ncpObl arcs. The best lung sparing was achieved using ncpObl arcs, which was statistically significant (p < 0.001) compared with the other four plans at V12.5Gy, V13.5Gy and V20Gy. Chest wall V30Gy was significantly better using noncoplanar arcs in comparison to the other plan types (p < 0.001). The best heart sparing at V10Gy from the ncpOBL arcs was significant compared with the clinical and cpLat plans (p < 0.005). Arc geometry has a substantial effect on lung SBRT plan quality. Noncoplanar arcs were superior to coplanar arcs at compacting the dose distribution at the 25%, 50% and 75% isodose levels, thereby reducing the dose to healthy tissues. Further healthy tissue sparing was achieved using oblique arcs that minimize the pathlength through healthy tissues and avoid organs at risk. The dosimetric advantages of the noncoplanar and oblique arcs require careful beam angle selection during treatment planning to avoid collisions during treatment, which may be facilitated by commercial software.
Collapse
|
4
|
Khan MI, Rehman JU, Afzal M, Chow JC. Comparison of plan dosimetry on multi-targeted lung radiotherapy: A phantom-based computational study using IMRT and VMAT. NUCLEAR ENGINEERING AND TECHNOLOGY 2022. [DOI: 10.1016/j.net.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Qilin Z, Peng B, Ang Q, Weijuan J, Ping J, Hongqing Z, Bin D, Ruijie Y. The feasibility study on the generalization of deep learning dose prediction model for volumetric modulated arc therapy of cervical cancer. J Appl Clin Med Phys 2022; 23:e13583. [PMID: 35262273 PMCID: PMC9195039 DOI: 10.1002/acm2.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/23/2021] [Accepted: 02/19/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To develop a 3D‐Unet dose prediction model to predict the three‐dimensional dose distribution of volumetric modulated arc therapy (VMAT) for cervical cancer and test the dose prediction performance of the model in endometrial cancer to explore the feasibility of model generalization. Methods One hundred and seventeen cases of cervical cancer and 20 cases of endometrial cancer treated with VMAT were used for the model training, validation, and test. The prescribed dose was 50.4 Gy in 28 fractions. Eight independent channels of contoured structures were input to the model, and the dose distribution was used as the output of the model. The 3D‐Unet prediction model was trained and validated on the training set (n = 86) and validation set (n = 11), respectively. Then the model was tested on the test set (n = 20) of cervical cancer and endometrial cancer, respectively. The results between clinical dose distribution and predicted dose distribution were compared in the following aspects: (a) the mean absolute error (MAE) within the body, (b) the Dice similarity coefficients (DSCs) under different isodose volumes, (c) the dosimetric indexes including the mean dose (Dmean), the received dose of 2 cm3 (D2cc), the percentage volume of receiving 40 Gy dose of organs‐at‐risk (V40), planning target volume (PTV) D98%, and homogeneity index (HI), (d) dose–volume histograms (DVHs). Results The model can accurately predict the dose distribution of the VMAT plan for cervical cancer and endometrial cancer. The overall average MAE and maximum MAE for cervical cancer were 2.43 ± 3.17% and 3.16 ± 4.01% of the prescribed dose, respectively, and for endometrial cancer were 2.70 ± 3.54% and 3.85 ± 3.11%. The average DSCs under different isodose volumes is above 0.9. The predicted dosimetric indexes and DVHs are equivalent to the clinical dose for both cervical cancer and endometrial cancer, and there is no statistically significant difference. Conclusion A 3D‐Unet dose prediction model was developed for VMAT of cervical cancer, which can predict the dose distribution accurately for cervical cancer. The model can also be generalized for endometrial cancer with good performance.
Collapse
Affiliation(s)
- Zhang Qilin
- Department of Radiation OncologyPeking University Third HospitalBeijingChina
| | - Bao Peng
- Center for Data ScienceAcademy for Advanced Interdisciplinary StudiesPeking UniversityBeijingChina
| | - Qu Ang
- Department of Radiation OncologyPeking University Third HospitalBeijingChina
| | - Jiang Weijuan
- Department of Radiation OncologyPeking University Third HospitalBeijingChina
| | - Jiang Ping
- Department of Radiation OncologyPeking University Third HospitalBeijingChina
| | - Zhuang Hongqing
- Department of Radiation OncologyPeking University Third HospitalBeijingChina
| | - Dong Bin
- Beijing International Center for Mathematical ResearchPeking UniversityBeijingChina
| | - Yang Ruijie
- Department of Radiation OncologyPeking University Third HospitalBeijingChina
| |
Collapse
|
6
|
Duan Y, Zhou L, Wang H, Chen H, Gu H, Shao Y, Feng A, Huang Y, Fu X, Yue NJ, Ma K, Kong Q, Xu Z. A novel CRT-IMRT-combined (Co-CRIM) planning technique for peripheral lung stereotactic body radiotherapy in pinnacle treatment planning system. J Appl Clin Med Phys 2021; 22:97-107. [PMID: 34699670 PMCID: PMC8664147 DOI: 10.1002/acm2.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/27/2021] [Accepted: 10/10/2021] [Indexed: 12/31/2022] Open
Abstract
Objectives This study attempts to explore a novel peripheral lung stereotactic body radiotherapy (SBRT) planning technique that can balance the pros and cons of three‐dimensional conformal radiotherapy (CRT) and intensity‐modulated radiation therapy (IMRT) / volumetric modulated arc therapy (VMAT). Methods Treatment plans were retrospectively designed based on CRT, IMRT, VMAT, and the proposed CRT‐IMRT‐combined (Co‐CRIM) techniques using Pinnacle treatment planning system (TPS) for 20 peripheral lung cancer patients. Co‐CRIM used an inverse optimization algorithm available in Pinnacle TPS. To develop a Co‐CRIM plan, the number of segments in each field was limited to one, the minimum segment area was set to the internal target volume (ITV), and the minimum monitor units (MU) of the segment was the quotient of fractional dose divided by twice the number of total fields. The performance of Co‐CRIM was then compared with other techniques. Results For conformity index (CI), Co‐CRIM performed comparably to IMRT/VMAT but better than CRT. For gradient index (GI), Co‐CRIM was similar to IMRT/VMAT or CRT. For heterogeneity index (HI), Co‐CRIM was comparable to IMRT/VMAT, higher than CRT. The dosimetric results of spinal cord and lung with Co‐CRIM were better than CRT, comparable to IMRT, but inferior to VMAT. The MU resulted from Co‐CRIM was lower than IMRT/VMAT but higher than CRT. For plan verification γ passing rate, Co‐CRIM was higher than IMRT/VMAT, comparable to CRT. For planning time, Co‐CRIM was shorter than CRT or VMAT but similar to IMRT. Conclusions The proposed Co‐CRIM technique on Pinnacle TPS is an effective planning technique for peripheral lung SBRT.
Collapse
Affiliation(s)
- YanHua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - LiJun Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - HengLe Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - AiHui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - XiaoLong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ning Jeff Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Jersey, USA
| | - Kui Ma
- Clinical helpdesk, Varian Medical Systems, Beijing, China
| | - Qing Kong
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - ZhiYong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
7
|
Tian X, Li C, Liu H, Li P, He J, Gao W. Applications of artificial intelligence in radiophysics. J Cancer Res Ther 2021; 17:1603-1607. [DOI: 10.4103/jcrt.jcrt_1438_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
8
|
Bourbonne V, Delafoy A, Lucia F, Quéré G, Pradier O, Schick U. Toxicity after volumetric modulated arc therapy for lung cancer: a monocentric retrospective study. Transl Lung Cancer Res 2021; 10:156-166. [PMID: 33569301 PMCID: PMC7867762 DOI: 10.21037/tlcr-20-406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Intensity-modulated radiotherapy (RT) is now widely implemented and has replaced classical three-dimensional (3D)-RT in many tumor sites, as it allows a better target dose conformity and a better sparing of organs a risk (OAR), at the expense, however, of increasing the volume of low dose to normal tissues. Clinical data on toxicities using volumetric modulated arc therapy (VMAT) in lung cancer remain scarce. We aimed to report both acute (APT) and late (LPT) pulmonary and acute (AET) and late (LET) oesophageal toxicities in such setting. Methods All patients treated for a primary lung cancer with VMAT +/- chemotherapy (ChT) in our center from 2014 to 2018 were retrospectively included. Usual clinical, treatment and dosimetric features were collected. Univariate analysis was performed using the receiver operative characteristics approach while multivariate analysis (MVA) relied on logistic regression, calculated with Medcalc 14.8.1. Results In total, 167 patients were included, with a median age of 66 years (39-88 years). Median radiation dose was 66 Gy (30-66 Gy); 82% patients received concomitant (32.3%), induction (25.7%) or induction followed by concomitant ChT (24%). After a median follow-up of 14.0 months, the G ≥2 APT, AET, LPT and LET rates were 22.2%, 30.0%, 16.8% and 5.4%, respectively with low grade ≥3 toxicity rates (respectively, 3%, 6.6%, 3% and 0%). On MVA, APT was significantly associated with V30 to the homolateral lung, AET with age, LPT with MEVS while no feature remained significantly correlated with LET. Conclusions Low rates of pulmonary and esophageal toxicity were observed in our cohort. Larger prospective studies are needed to confirm these results.
Collapse
Affiliation(s)
- Vincent Bourbonne
- Radiation Oncology Department, CHRU Brest, Brest, France.,LaTIM, INSERM UMR 1101, Univ Brest, Brest, France
| | - Alice Delafoy
- Radiation Oncology Department, CHRU Brest, Brest, France
| | - François Lucia
- Radiation Oncology Department, CHRU Brest, Brest, France.,LaTIM, INSERM UMR 1101, Univ Brest, Brest, France
| | - Gilles Quéré
- Medical Oncology Department, CHRU Brest, Brest, France
| | - Olivier Pradier
- Radiation Oncology Department, CHRU Brest, Brest, France.,LaTIM, INSERM UMR 1101, Univ Brest, Brest, France
| | - Ulrike Schick
- Radiation Oncology Department, CHRU Brest, Brest, France.,LaTIM, INSERM UMR 1101, Univ Brest, Brest, France
| |
Collapse
|
9
|
Bai L, Xiao Q, Wang Q, Zhao J, Li G, Bai S. Dosimetric characteristics of a 2D silicon diode array for stereotactic radiotherapy end-to-end patient-specific QA. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.108885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
10
|
Kawamura T, Fujii Y, Tokura S, Kaneda K, Fujita M, Murakami N, Kuriyama Y, Miyawaki D, Hase M. [Dose Verification for Respiratory-gated VMAT-SBRT Using Real-time Tumor Tracking System]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:674-688. [PMID: 32684560 DOI: 10.6009/jjrt.2020_jjrt_76.7.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recently, the introduction of various novel technologies in clinical settings has improved the accuracy of radiation therapy. Stereotactic body radiation therapy (SBRT) involves the delivery of an accurate radiation dose to the tumor with a minimal impact on normal tissues using various measures to address changes in the tumor position due to respiratory displacement. The SyncTraX FX4 real-time tumor tracking system (Shimadzu Corporation) introduced in our hospital tracks the actual tumor location by radioscopically monitoring a metallic marker that is placed in the vicinity of the tumor. However, there have been no reports yet on respiratory-gated volumetric modulated arc therapy (VMAT)-SBRT using a real-time tumor tracking system. This study aimed to develop an irradiation procedure for respiratory-gated VMAT-SBRT using a real-time tumor tracking system and to evaluate radiation doses therein. In this study, we found that absolute doses with respiratory gating did not deviate by more than ±1.0% from those without respiratory gating. In addition, the pass rate in gamma analysis using GAFCHROMIC EBT3 was ³95% with the pass criteria in dose difference, distance to agreement, and threshold being 2%, 2 mm, and 10%, respectively. Furthermore, a trajectory log file analysis did not reveal any significant error causes. Thus, these data indicate that respiratory-gated VMAT-SBRT can be applied clinically.
Collapse
Affiliation(s)
- Tetsuro Kawamura
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Yusuke Fujii
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Shinsuke Tokura
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Kazunori Kaneda
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Masahiro Fujita
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Naoki Murakami
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Yukiharu Kuriyama
- Department of Radiological Technology, Kakogawa Central City Hospital
| | - Daisuke Miyawaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine
| | - Mamoru Hase
- Department of Radiology, Kakogawa Central City Hospital
| |
Collapse
|
11
|
Liu G, Yang J, Nie X, Zhu X, Li X, Zhou J, Kabolizadeh P, Li Q, Quan H, Ding X. A Patients-Based Statistical Model of Radiotherapy Dose Distribution in Nasopharyngeal Cancer. Dose Response 2019; 17:1559325819892359. [PMID: 31857802 PMCID: PMC6913054 DOI: 10.1177/1559325819892359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/20/2019] [Accepted: 11/05/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose: To develop a patients-based statistical model of dose distribution among patients with nasopharyngeal cancer (NPC). Methods and Materials: The dose distributions of 75 patients with NPC were acquired and preprocessed to generate a dose-template library. Subsequently, the dominant modes of dose distribution were extracted using principal component analysis (PCA). Leave-one-out cross-validation (LOOCV) was performed for evaluation. Residual reconstruction errors between the doses reconstructed using different dominating eigenvectors and the planned dose distribution were calculated to investigate the convergence characteristics. Three-dimensional Gamma analysis was performed to investigate the accuracy of dose reconstruction. Results: The first 29 components contained 90% of the variance in dose distribution, and 45 components accounted for more than 95% of the variance on average. The residual error of the LOOCV model for the cumulative sum of components over all patients decreased from 8.16 to 4.79 Gy when 1 to 74 components were included in the LOOCV model. The 3-dimensional Gamma analysis results implied that the PCA model was capable of dose distribution reconstruction, and the accuracy was especially satisfactory in the high-dose area. Conclusions: A PCA-based model of dose distribution variations in patients with NPC was developed, and its accuracy was determined. This model could serve as a predictor of 3-dimensional dose distribution.
Collapse
Affiliation(s)
- Gang Liu
- Key laboratory of Artificial Micro- and Nano-Structures of the Ministry of Education and Center for Electronic Microscopy, School of Physics and Technology, Wuhan University, China.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Jing Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Nie
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohui Zhu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Jun Zhou
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Peyman Kabolizadeh
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Qin Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Quan
- Key laboratory of Artificial Micro- and Nano-Structures of the Ministry of Education and Center for Electronic Microscopy, School of Physics and Technology, Wuhan University, China
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| |
Collapse
|
12
|
Mix M, Tanny S, Nsouli T, Alden R, Chaudhari R, Kincaid R, Rosenbaum PF, Bogart JA, Aridgides P. Outcomes Following Stereotactic Body Radiotherapy with Intensity-Modulated Therapy versus Three-Dimensional Conformal Radiotherapy in Early Stage Non-Small Cell Lung Cancer. LUNG CANCER-TARGETS AND THERAPY 2019; 10:151-159. [PMID: 31908556 PMCID: PMC6929968 DOI: 10.2147/lctt.s235713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/29/2019] [Indexed: 11/23/2022]
Abstract
Introduction The treatment techniques used for stereotactic body radiation therapy (SBRT) for early-stage lung cancer continue to evolve. In this study, clinical outcomes following SBRT were evaluated according to the use of either 3D conformal radiotherapy (3DCRT) or intensity-modulated radiation therapy (IMRT). Patients and methods Patients with stage I NSCLC who received SBRT from 2007 to 2015 were retrospectively reviewed. Disease control and survival were assessed using Kaplan-Meier estimates. Dosimetric analyses for target dose heterogeneity and coverage were performed. Results A total of 297 patients with 351 lesions were included. 3DCRT was used in 52% and IMRT in 48%. IMRT was utilized at a higher rate in more recent years. The most common regimens were 48 Gy in 4 fractions and 54-60 Gy in 3 fractions. With a median follow up of 22.7 months, there were 17 local failures for a crude relapse rate of 5.7%. Local failure did not differ in patients treated with 3DCRT and IMRT (4.9% vs 6.5%, p=0.573). Mean dose to gross tumor volume (GTV) as a percent of prescription dose was higher with 3DCRT compared with IMRT (107.7% vs 103.6%, p < 0.0001). Tumor stage, histology, and SBRT regimen did not correlate with local tumor control. Overall survival for the entire population approximated 72% at 2 years. Treatment was well tolerated with 6 documented grade 3+ events. Conclusion In this single-institution cohort of SBRT for early-stage NSCLC, there was no discernible difference in clinical outcomes between those treated with 3DCRT and IMRT.
Collapse
Affiliation(s)
- Michael Mix
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Sean Tanny
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Tamara Nsouli
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Ryan Alden
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Rishabh Chaudhari
- Department of Radiation Oncology, University of Cincinnati/University Hospital Barrett Cancer Center, Cincinatti, OH 45267, USA
| | - Russell Kincaid
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Paula F Rosenbaum
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Jeffrey A Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Paul Aridgides
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| |
Collapse
|
13
|
Roberts NF, Williams M, Holloway L, Metcalfe P, Oborn BM. 4D Monte Carlo dose calculations for pre-treatment quality assurance of VMAT SBRT: a phantom-based feasibility study. Phys Med Biol 2019; 64:21NT01. [PMID: 31470421 DOI: 10.1088/1361-6560/ab3fd0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Volumetric arc therapy (VMAT) for lung stereotactic body radiotherapy (SBRT) is challenging due to both breathing-induced motion and the dynamic components of the linear accelerator. In this study, a 4D Monte Carlo (4DMC) dose calculation method for VMAT SBRT is proposed and the feasibility of the method is evaluated. A rigidly-moving lung phantom was imaged using four dimensional computed tomography (4DCT). VMAT SBRT plans were generated on the average intensity projection dataset using the internal target volume (ITV) strategy (ITV-plan) and a single phase to simulate a dynamic treatment-couch tracking technique (TRACKING-plan). 4DMC simulations were performed and compared to 3D Monte Carlo (3DMC) and 3D- and 4D- calculations in the treatment planning system using the adaptive convolution (AC) algorithm. Dose metrics calculated for the ITV-plan showed an overestimation with 3D adaptive convolution (3DAC) for D[Formula: see text] (GTV) by 3.5% and by 2.0% for 3DMC, both compared to 4DMC. The TRACKING-plan D[Formula: see text] (GTV) calculated with the 3DAC method overestimated by 2.0% compared with 4DMC. Deviations between the calculation methods for D mean (Lung) and D[Formula: see text] (PTV) were minimal. For both plans, measurements were taken with EBT3 film inside the phantom tumour. EBT3 film profiles showed good agreement with 4DMC for the TRACKING-plan giving a gamma pass rate of 97.2% for 3%/3 mm global and for 3DAC compared with measured, 95.8%. Whereas for the ITV-plan, the 3D profiles varied from film in the ITV periphery region with a pass rates of 50% and 48.6% for 3DAC and 3DMC, respectively. 4DMC agreed more closely to measurements for this plan with a pass rate of 95.8%. We have proposed an accurate method to perform 4D dose calculations for pre-treatment quality assurance of VMAT SBRT. The method was compared to experimental measurements and for both plans, 4DMC dose agreed with measurements more closely than other evaluated dose calculation methods. This study has demonstrated the feasibility of this 4DMC method.
Collapse
Affiliation(s)
- Natalia F Roberts
- Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, NSW, Australia. Centre for Oncology Education and Research Translation (CONCERT), Wollongong, NSW, Australia. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia. Author to whom correspondence should be addressed
| | | | | | | | | |
Collapse
|
14
|
Cilla S, Ianiro A, Craus M, Viola P, Deodato F, Macchia G, Buwenge M, Morganti AG, Valentini V, Piermattei A. Epid-based in vivo dose verification for lung stereotactic treatments delivered with multiple breath-hold segmented volumetric modulated arc therapy. J Appl Clin Med Phys 2019; 20:37-44. [PMID: 30790439 PMCID: PMC6414179 DOI: 10.1002/acm2.12538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/13/2018] [Accepted: 01/02/2019] [Indexed: 12/31/2022] Open
Abstract
We evaluated an EPID-based in-vivo dosimetry (IVD) method for the dose verification and the treatment reproducibility of lung SBRT-VMAT treatments in clinical routine. Ten patients with lung metastases treated with Elekta VMAT technique were enrolled. All patients were irradiated in five consecutive fractions, with total doses of 50 Gy. Set-up was carried out with the Elekta stereotactic body frame. Eight patients were simulated and treated using the Active Breath Control (ABC) system, a spirometer enabling patients to maintain a breath-hold at a predetermined lung volume. Two patients were simulated and treated in free-breathing using an abdominal compressor. IVD was performed using the SOFTDISO software. IVD tests were evaluated by means of (a) ratio R between daily in-vivo isocenter dose and planned dose and (b) γ-analysis between EPID integral portal images in terms of percentage of points with γ-value smaller than one (γ% ) and mean γ-values (γmean ) using a 3%(global)/3 mm criteria. Alert criteria of ±5% for R ratio, γ% < 90%, and γmean > 0.67 were chosen. 50 transit EPID images were acquired. For the patients treated with ABC spirometer, the results reported a high level of accuracy in dose delivery with 100% of tests within ±5%. The γ-analysis showed a mean value of γmean equal to 0.21 (range: 0.04-0.56) and a mean γ% equal to 96.9 (range: 78-100). Relevant discrepancies were observed only for the two patients treated without ABC, mainly due to a blurring dose effect due to residual respiratory motion. Our method provided a fast and accurate procedure in clinical routine for verifying delivered dose as well as for detecting errors.
Collapse
Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Anna Ianiro
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Maurizio Craus
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Pietro Viola
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Department, DIMES Università di Bologna - Ospedale S.Orsola Malpighi, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, DIMES Università di Bologna - Ospedale S.Orsola Malpighi, Bologna, Italy
| | - Vincenzo Valentini
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Angelo Piermattei
- Medical Physics Unit, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
15
|
Sun Y, Liu G, Chen W, Chen T, Liu P, Zeng Q, Hong J, Wei R. Dosimetric comparisons of craniospinal axis irradiation using helical tomotherapy, volume-modulated arc therapy and intensity-modulated radiotherapy for medulloblastoma. Transl Cancer Res 2019; 8:191-202. [PMID: 35116748 PMCID: PMC8797767 DOI: 10.21037/tcr.2019.01.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/15/2019] [Indexed: 11/06/2022]
Abstract
Background To evaluate the potential dosimetric gains of helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT) and volume-modulated arc therapy (VMAT) for craniospinal axis irradiation (CSI) of medulloblastoma. Methods A total of 36 treatment plans were calculated retrospectively for 12 patients with medulloblastoma receiving CSI using HT with TomoTherapy Hi-Art Software (Version 2.0.7) (Accuray, Madison, WI, USA). For each case, the other two different delivery techniques were re-planned with IMRT/VMAT optimized with Eclipse treatment planning system (TPS) (Version 11.0.31). Homogeneity index (HI) and conformity index (CI) of the planning target volume (PTV) and organs at risk (OARs) sparing were analyzed. Differences in plans were evaluated using paired-samples t-test for various dosimetric parameters. Results HT yielded the highest CI in all PTV coverage including PTV of gross tumor volume (PGTV) (HT: 0.7163; VMAT: 0.6688; IMRT: 0.6096), PTVbrain (HT: 0.8490; VMAT: 0.8384; IMRT: 0.7815) and PTVspine (HT: 0.5904; VMAT: 0.5862; IMRT: 0.5797). Meanwhile, HT yielded better HI in PGTV (HT: 0.0543; VMAT: 0.0759; IMRT: 0.0736), PTVbrain (HT: 0.5525; VMAT: 0.5619; IMRT: 0.5554) and PTVspine (HT: 0.0700; VMAT: 0.0782; IMRT: 0.0877). As for OARs, HT demonstrated marked superiority in critical organs including maximal/mean doses of brainstem PRV, optical chiasm and optic nerves. Conclusions For CSI of medulloblastoma, HT offers superior outcomes in terms of PTV conformity, PTV homogeneity and critical OAR sparing as compared with IMRT/VMAT.
Collapse
Affiliation(s)
- Yangqing Sun
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Gui Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wen Chen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Taili Chen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Pei Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Qian Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jidong Hong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| |
Collapse
|
16
|
Liu C, Sio TT, Deng W, Shan J, Daniels TB, Rule WG, Lara PR, Korte SM, Shen J, Ding X, Schild SE, Bues M, Liu W. Small-spot intensity-modulated proton therapy and volumetric-modulated arc therapies for patients with locally advanced non-small-cell lung cancer: A dosimetric comparative study. J Appl Clin Med Phys 2018; 19:140-148. [PMID: 30328674 PMCID: PMC6236833 DOI: 10.1002/acm2.12459] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare dosimetric performance of volumetric‐modulated arc therapy (VMAT) and small‐spot intensity‐modulated proton therapy for stage III non‐small‐cell lung cancer (NSCLC). Methods and Materials A total of 24 NSCLC patients were retrospectively reviewed; 12 patients received intensity‐modulated proton therapy (IMPT) and the remaining 12 received VMAT. Both plans were generated by delivering prescription doses to clinical target volumes (CTV) on averaged 4D‐CTs. The dose‐volume‐histograms (DVH) band method was used to quantify plan robustness. Software was developed to evaluate interplay effects with randomized starting phases of each field per fraction. DVH indices were compared using Wilcoxon rank sum test. Results Compared with VMAT, IMPT delivered significantly lower cord Dmax, heart Dmean, and lung V5 Gy[RBE] with comparable CTV dose homogeneity, and protection of other OARs. In terms of plan robustness, the IMPT plans were statistically better than VMAT plans in heart Dmean, but were statistically worse in CTV dose coverage, cord Dmax, lung Dmean, and V5 Gy[RBE]. Other DVH indices were comparable. The IMPT plans still met the standard clinical requirements with interplay effects considered. Conclusions Small‐spot IMPT improves cord, heart, and lung sparing compared to VMAT and achieves clinically acceptable plan robustness at least for the patients included in this study with motion amplitude less than 11 mm. Our study supports the usage of IMPT to treat some lung cancer patients.
Collapse
Affiliation(s)
- Chenbin Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Wei Deng
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jie Shan
- Department of Biomedical Informatics, Arizona State University, Tempe, AZ, USA
| | | | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Pedro R Lara
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Shawn M Korte
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jiajian Shen
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Xiaoning Ding
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
17
|
Wang Y, Chen L, Zhu F, Guo W, Zhang D, Sun W. A study of minimum segment width parameter on VMAT plan quality, delivery accuracy, and efficiency for cervical cancer using Monaco TPS. J Appl Clin Med Phys 2018; 19:609-615. [PMID: 30058257 PMCID: PMC6123131 DOI: 10.1002/acm2.12422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 11/15/2022] Open
Abstract
Purpose The purpose of this study was to study the influence of the minimum segment width (MSW) on volumetric modulated arc therapy (VMAT) plan quality, delivery accuracy, and efficiency for cervical cancer treatment. Methods Nineteen patients with cervical cancer were randomly selected to design VMAT plans. Three VMAT plans were generated for each patient incorporating MSWs of 0.5, 1.0, and 1.5 cm while other planning parameters remained constant using the Monaco treatment planning system (TPS) with 6 MV X rays delivered from an Elekta Synergy linear accelerator. Plan quality and delivery efficiency were evaluated based on dose‐volume histograms (DVHs), control points, monitor units (MUs), dosimetric measurement verification results, and plan delivery time. Results Except for the small difference in target dose coverage and maximum dose, there were no statistically significant differences between the other dosimetric parameters in the planning target volumes. The 1.0 and 1.5 cm MSW plans showed lower maximum doses to the spinal cord than the 0.5 cm plan; doses to other organs at risks were similar regardless of MSWs. The mean reductions of total MUs when compared with the 0.5 cm plan were 14.5 ± 6.1% and 20.9 ± 7.9% for MSWs of 1.0 and 1.5 cm, respectively. The calculated gamma indices using the 3% and 3 mm criteria were 96.2 ± 0.6%, 97.0 ± 0.6%, and 97.6 ± 0.6% for the 0.5, 1.0 and 1.5 cm MSW plans, respectively. The plan delivery times decreased with increasing MSWs (p < 0.05). Conclusion Increasing the MSW allows for improved plan delivery accuracy and efficiency without significantly affecting the VMAT plan quality. MSWs of 1.0 and 1.5 cm improved the plan quality, delivery accuracy, and efficiency for cervical VMAT radiation therapy.
Collapse
Affiliation(s)
- Yuanyuan Wang
- Department of Radiation Oncology, Hefei Ion Medical Center, Hefei, China
| | - Li Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fengying Zhu
- Shunde Hospital of Southern Medical University, Shunde, China
| | | | - Dandan Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wenzhao Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
18
|
Shrimali RK, Arunsingh M, Reddy GD, Mandal S, Arun B, Prasath S, Sinha S, Mallick I, Achari R, Chatterjee S. Actual gains in dosimetry and treatment delivery efficiency from volumetric modulated arc radiotherapy for inoperable, locally advanced lung cancer over five-field forward-planned intensity-modulated radiotherapy. Indian J Cancer 2018; 54:155-160. [PMID: 29199680 DOI: 10.4103/ijc.ijc_79_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Volumetric modulated arc radiotherapy (VMAT) is used for inoperable, locally advanced nonsmall cell lung cancer, where three-dimensional conformal radiotherapy (3D-CRT) cannot yield an acceptable plan. METHODS The planning and treatment data were prospectively collected on the first 18 patients treated using VMAT plans. We analyzed the actual dosimetric gain and impact on treatment, compared with complex multisegment 3D-CRT (five-field forward-planned intensity-modulated radiotherapy [IMRT]) that were generated for treatment. Proportion of planning target volume (PTV) receiving 95% dose (PTV-V95%) conformity index (CI), conformity number (CN), dose homogeneity index (DHI), monitor units (MUs), and treatment time were also analyzed. RESULTS The PTV coverage (PTV-V95%) was improved from a median of 91.41% for 5-F forward-IMRT to 98.25% for VMAT (P < 0.001). The CI improved with a mean of 1.12 for VMAT and 1.31 for 5-F forward-IMRT (P < 0.001). The mean DHI improved from 1.15 for forward-IMRT to 1.08 for VMAT (P < 0.001). The mean CN improved from 0.62 for forward-IMRT to 0.87 for VMAT (P < 0.001). No significant increase in the low-dose bath (V5, V10 and mean lung dose) to the lung was seen. Significantly higher number of MUs (P < 0.001) and shorter treatment delivery times (P = 0.03) were seen with VMAT. CONCLUSION VMAT resulted in improvement in target volume coverage, demonstrated by PTV-V95%, CI, CN, and DHI, without any increase in the low-dose bath to the lung. For conventional fractionation, VMAT requires more MUs (P < 0.001) but has a shorter treatment delivery time (P = 0.03) per fraction.
Collapse
Affiliation(s)
- R K Shrimali
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - G D Reddy
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - S Mandal
- Department of Medical Physics, Tata Medical Centre, Kolkata, West Bengal, India
| | - B Arun
- Department of Medical Physics, Tata Medical Centre, Kolkata, West Bengal, India
| | - S Prasath
- Department of Medical Physics, Tata Medical Centre, Kolkata, West Bengal, India
| | - S Sinha
- Department of Medical Statistics, Tata Medical Centre, Kolkata, West Bengal, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - R Achari
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| |
Collapse
|
19
|
Mori S, Takei Y, Shirai T, Hara Y, Furukawa T, Inaniwa T, Tanimoto K, Tajiri M, Kuroiwa D, Kimura T, Yamamoto N, Yamada S, Tsuji H, Kamada T. Scanned carbon-ion beam therapy throughput over the first 7 years at National Institute of Radiological Sciences. Phys Med 2018; 52:18-26. [PMID: 30139605 DOI: 10.1016/j.ejmp.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/14/2018] [Accepted: 06/02/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION In the 7 years since our facility opened, we have treated >2000 patients with pencil-beam scanned carbon-ion beam therapy. METHODS To summarize treatment workflow, we evaluated the following five metrics: i) total number of treated patients; ii) treatment planning time, not including contouring procedure; iii) quality assurance (QA) time (daily and patient-specific); iv) treatment room occupancy time, including patient setup, preparation time, and beam irradiation time; and v) daily treatment hours. These were derived from the oncology information system and patient handling system log files. RESULTS The annual number of treated patients reached 594, 7 years from the facility startup, using two treatment rooms. Mean treatment planning time was 6.0 h (minimum: 3.4 h for prostate, maximum: 9.3 h for esophagus). Mean time devoted to daily QA and patient-specific QA were 22 min and 13.5 min per port, respectively, for the irradiation beam system. Room occupancy time was 14.5 min without gating for the first year, improving to 9.2 min (8.2 min without gating and 12.8 min with gating) in the second. At full capacity, the system ran for 7.5 h per day. CONCLUSIONS We are now capable of treating approximately 600 patients per year in two treatment rooms. Accounting for the staff working time, this performance appears reasonable compared to the other facilities.
Collapse
Affiliation(s)
- Shinichiro Mori
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan.
| | - Yuka Takei
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Toshiyuki Shirai
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Yousuke Hara
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Takuji Furukawa
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Taku Inaniwa
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Katsuyuki Tanimoto
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Minoru Tajiri
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Daigo Kuroiwa
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Taku Kimura
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Naoyoshi Yamamoto
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Shigeru Yamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Hiroshi Tsuji
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba 263-0024, Japan
| |
Collapse
|
20
|
Jeevanandam P, Agnew CE, Irvine DM, McGarry CK. Improvement of off-axis SABR plan verification results by using adapted dose reconstruction algorithms for the Octavius 4D system. Med Phys 2018; 45:1738-1747. [PMID: 29431850 DOI: 10.1002/mp.12805] [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: 06/05/2017] [Revised: 12/11/2017] [Accepted: 01/26/2018] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Stereotactic ablative body radiotherapy (SABR) for lung patients can be performed with volumetric-modulated arc therapy (VMAT) plans using off-axis target geometry to allow treatment in their CBCT verified position. For patient-specific quality assurance measurements using the PTW Octavius 4D phantom (PTW, Freiburg, Germany) (OCT4D) in conjunction with an Octavius 1000SRS array (OCT1000) (PTW, Freiburg, Germany), repositioning the phantom off-axis is required to ensure the measurement area coincides with the tumor. The aim of this work is to quantify delivery errors using an array repositioned off-axis and evaluate new software which incorporates corrections for off-axis phantom measurements. METHODS Dynamic conformal arcs and 25 lung SABR plans were created with the isocenter at the patient midline and the target volume off-axis. Measurements were acquired with an OCT4D phantom in conjunction with a 729 array (PTW, Freiburg, Germany) (OCT729) placed at isocenter. These plans were recalculated and delivered to both the OCT729 and OCT1000 arrays repositioned so that the high-dose region was at the center of the phantom. Comparisons were made using VeriSoft v7.0 (PTW, Freiburg, Germany) and the newly implemented version 7.1 with 2%/2 mm gamma criterion (10% threshold) and results correlated with off-axis distance to the tumor. RESULTS Average pass rates for VeriSoft v7.0 significantly reduced from 92.7 ± 2.4% to 84.9 ± 4.1% when the phantom was repositioned compared to the isocenter setup for the OCT729. The gamma pass rates significantly decreased the further the phantom was moved off-axis. Significantly higher pass rates were observed for the OCT1000 of 95.7 ± 3.6% and a significant decrease in gamma pass rate with off-axis phantom distance was again observed. In contrast, even with phantom repositioning, the pass rates for analysis with VeriSoft v7.1 were 93.7 ± 2.1% and 99.4 ± 1.1% for OCT729 and OCT1000, respectively. No significant difference in gamma pass rate was observed with off-axis phantom position irrespective of array type with the new software. CONCLUSION The errors in QA phantom measurements due to dose reconstruction at off-axis target geometry have been demonstrated for conformal arcs and clinical VMAT SABR plans. A novel software solution implemented by the vendor to allow accurate pass rates has been tested. This solution enables high-resolution arrays with small active detection areas to be used for quality assurance of SABR treatment plans in the off-axis treatment position.
Collapse
Affiliation(s)
- Prakash Jeevanandam
- Northern Ireland Cancer Center, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Christina E Agnew
- Northern Ireland Cancer Center, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Denise M Irvine
- Northern Ireland Cancer Center, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Conor K McGarry
- Northern Ireland Cancer Center, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK.,Centre for Cancer Research and Cell Biology, Queen's University, 79 Lisburn Road, Belfast, BT9 7AE, UK
| |
Collapse
|
21
|
Under-reported dosimetry errors due to interplay effects during VMAT dose delivery in extreme hypofractionated stereotactic radiotherapy. Strahlenther Onkol 2018; 194:570-579. [PMID: 29450592 DOI: 10.1007/s00066-018-1264-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 01/05/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy of extracranial metastases changed from normofractioned 3D CRT to extreme hypofractionated stereotactic treatment using VMAT beam techniques. Random interaction between tumour motion and dynamically changing beam parameters might result in underdosage of the CTV even for an appropriately dimensioned ITV (interplay effect). This study presents a clinical scenario of extreme hypofractionated stereotactic treatment and analyses the impact of interplay effects on CTV dose coverage. METHODS For a thoracic/abdominal phantom with an integrated high-resolution detector array placed on a 4D motion platform, dual-arc treatment plans with homogenous target coverage were created using a common VMAT technique and delivered in a single fraction. CTV underdosage through interplay effects was investigated by comparing dose measurements with and without tumour motion during plan delivery. RESULTS Our study agrees with previous works that pointed out insignificant interplay effects on target coverage for very regular tumour motion patterns like simple sinusoidal motion. However, we identified and illustrated scenarios that are likely to result in a clinically relevant CTV underdosage. For tumour motion with abnormal variability, target coverage quantified by the CTV area receiving more than 98% of the prescribed dose decreased to 78% compared to 100% at static dose measurement. CONCLUSION This study is further proof of considerable influence of interplay effects on VMAT dose delivery in stereotactic radiotherapy. For selected conditions of an exemplary scenario, interplay effects and related motion-induced target underdosage primarily occurred in tumour motion pattern with increased motion variability and VMAT plan delivery using complex MLC dose modulation.
Collapse
|
22
|
Aljabab S, Vellayappan B, Vandervoort E, Bahm J, Zohr R, Sinclair J, Caudrelier JM, Szanto J, Malone S. Comparison of four techniques for spine stereotactic body radiotherapy: Dosimetric and efficiency analysis. J Appl Clin Med Phys 2018; 19:160-167. [PMID: 29417728 PMCID: PMC5849852 DOI: 10.1002/acm2.12271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/17/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The aim of this study is to compare the dosimetric differences between four techniques for spine stereotactic body radiotherapy (SBRT): CyberKnife (CK), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT) with dynamic jaws (HT-D) and fixed jaws (HT-F). MATERIALS/METHODS Data from 10 patients were utilized. All patients were planned for 24 Gy in two fractions, with the primary objectives being: (a) restricting the maximum dose to the cord to ≤ 17 Gy and/or cauda equina to ≤ 20 Gy, and (b) to maximize the clinical target volume (CTV) to receive the prescribed dose. Treatment plans were generated by separate dosimetrists and then compared using velocity AI. Parameters of comparison include target volume coverage, conformity index (CI), gradient index (GI), homogeneity index (HI), treatment time (TT) per fraction, and monitor units (MU) per fraction. RESULTS PTV D2 and D5 were significantly higher for CK compared to VMAT, HT-F, and HT-D (P < 0.001). The average volume of CTV receiving the prescription dose (CTV D95) was significantly less for VMAT compared to CK, HT-F and HT-D (P = 0.036). CI improved for CK (0.69), HT-F (0.66), and HT-D (0.67) compared to VMAT (0.52) (P = 0.013). CK (41.86) had the largest HI compared to VMAT (26.99), HT-F (20.69), and HT-D (21.17) (P < 0.001). GI was significantly less for CK (3.96) compared to VMAT (6.76) (P = 0.001). Likewise, CK (62.4 min, 14059 MU) had the longest treatment time and MU per fraction compared to VMAT (8.5 min, 9764 MU), HT-F (13 min, 10822 MU), and HT-D (13.5 min, 11418 MU) (P < 0.001). CONCLUSION Both CK and HT plans achieved conformal target coverage while respecting cord tolerance. Dose heterogeneity was significantly larger in CK. VMAT required the least treatment time and MU output, but had the least steep GI, CI, and target coverage.
Collapse
Affiliation(s)
- Saif Aljabab
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | | | - Eric Vandervoort
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Jamie Bahm
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Robert Zohr
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - John Sinclair
- Division of Neurosurgery, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Michel Caudrelier
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Janos Szanto
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Shawn Malone
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
23
|
Li Y, Wang J, Tan L, Hui B, Ma X, Yan Y, Xue C, Shi X, Drokow EK, Ren J. Dosimetric comparison between IMRT and VMAT in irradiation for peripheral and central lung cancer. Oncol Lett 2018; 15:3735-3745. [PMID: 29467890 PMCID: PMC5795944 DOI: 10.3892/ol.2018.7732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to compare intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in irradiation of lung cancer. Plans of 14 patients were compared. The results demonstrated that in peripheral lung cancer, V5 (%) of the lung in partial-arc (PA)-VMAT was decreased compared with IMRT, single-arc (SA)-, and double partial-arc (2PA)-VMAT. V30 (%) of the lung in IMRT was decreased compared with SA-, PA- and 2PA-VMAT. In the case of planning target volume (PTV) not encompassing the mediastinum in central lung cancer, the conformality index (CI) and heterogeneity index (HI) of SA-VMAT was improved compared with IMRT, PA-, and 2PA-VMAT. The received dose of heart in SA-VMAT was higher compared with IMRT, PA- and 2PA-VMAT. V30 (%) and V5 (%) of the lung in IMRT was higher compared with SA-, PA- and 2PA-VMAT; V10 (%) of the lung in 2PA was decreased compared with IMRT, SA- and PA. In the case of PTV encompassing the mediastinum in central lung cancer, the HI and CI of 2PA was improved compared with IMRT, SA- and PA-VMAT. The received dose of heart in 2PA was higher compared with IMRT, SA- and PA-VMAT. V30 (%) and V5 (%) of the lung in 2PA-VMAT was higher compared with IMRT, SA- and PA-VMAT. V20 (%) of the lung in 2PA was decreased compared with IMRT, SA- and PA-VMAT. In conclusion, it may be necessary to classify the radiotherapy plans of lung cancer into three categories including peripheral lung cancer, PTV not encompassing the mediastinum of central lung cancer, and PTV encompassing the mediastinum of central lung cancer. Each of IMRT, SA-VMAT, PA-VMAT, 2PA-VMAT strategy had individual advantages, and therefore it may be crucial to employ different planning techniques for different disease classifications and OAR requirements.
Collapse
Affiliation(s)
- Yi Li
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Ji Wang
- Intensive Care Unit, China Meitan General Hospital, Beijing 100028, P.R. China
| | - Li Tan
- Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Beina Hui
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaowei Ma
- Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yanli Yan
- Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Chaofan Xue
- Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaoting Shi
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Emmanuel Kwateng Drokow
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Juan Ren
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| |
Collapse
|
24
|
Cilla S, Ianiro A, Deodato F, Macchia G, Digesù C, Valentini V, Morganti AG. Optimal beam margins in linac-based VMAT stereotactic ablative body radiotherapy: a Pareto front analysis for liver metastases. Med Dosim 2017; 43:291-301. [PMID: 29191470 DOI: 10.1016/j.meddos.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/21/2017] [Accepted: 10/23/2017] [Indexed: 12/11/2022]
Abstract
We explored the Pareto fronts mathematical strategy to determine the optimal block margin and prescription isodose for stereotactic body radiotherapy (SBRT) treatments of liver metastases using the volumetric-modulated arc therapy (VMAT) technique. Three targets (planning target volumes [PTVs] = 20, 55, and 101 cc) were selected. A single fraction dose of 26 Gy was prescribed (prescription dose [PD]). VMAT plans were generated for 3 different beam energies. Pareto fronts based on (1) different multileaf collimator (MLC) block margin around PTV and (2) different prescription isodose lines (IDL) were produced. For each block margin, the greatest IDL fulfilling the criteria (95% of PTV reached 100%) was considered as providing the optimal clinical plan for PTV coverage. Liver Dmean, V7Gy, and V12Gy were used against the PTV coverage to generate the fronts. Gradient indexes (GI and mGI), homogeneity index (HI), and healthy liver irradiation in terms of Dmean, V7Gy, and V12Gy were calculated to compare different plans. In addition, each target was also optimized with a full-inverse planning engine to obtain a direct comparison with anatomy-based treatment planning system (TPS) results. About 900 plans were calculated to generate the fronts. GI and mGI show a U-shaped behavior as a function of beam margin with minimal values obtained with a +1 mm MLC margin. For these plans, the IDL ranges from 74% to 86%. GI and mGI show also a V-shaped behavior with respect to HI index, with minimum values at 1 mm for all metrics, independent of tumor dimensions and beam energy. Full-inversed optimized plans reported worse results with respect to Pareto plans. In conclusion, Pareto fronts provide a rigorous strategy to choose clinical optimal plans in SBRT treatments. We show that a 1-mm MLC block margin provides the best results with regard to healthy liver tissue irradiation and steepness of dose fallout.
Collapse
Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II-Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - Anna Ianiro
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Cinzia Digesù
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vincenzo Valentini
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II-Università Cattolica del Sacro Cuore, Campobasso, Italy; Radiation Oncology Department, Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, DIMES Università di Bologna-Ospedale S.Orsola Malpighi, Bologna, Italy
| |
Collapse
|
25
|
Giglioli FR, Clemente S, Esposito M, Fiandra C, Marino C, Russo S, Strigari L, Villaggi E, Stasi M, Mancosu P. Frontiers in planning optimization for lung SBRT. Phys Med 2017; 44:163-170. [PMID: 28566240 DOI: 10.1016/j.ejmp.2017.05.064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 12/25/2022] Open
Abstract
Emerging data are showing the safety and the efficacy of Stereotactic Body Radiation therapy (SBRT) in lung cancer management. In this context, the very high doses delivered to the Planning Target Volume, make the planning phase essential for achieving high dose levels conformed to the shape of the target in order to have a good prognosis for tumor control and to avoid an overdose in relevant healthy adjacent tissue. In this non-systematic review we analyzed the technological and the physics aspects of SBRT planning for lung cancer. In particular, the aims of the study were: (i) to evaluate prescription strategies (homogeneous or inhomogeneous), (ii) to outline possible geometrical solutions by comparing the dosimetric results (iii) to describe the technological possibilities for a safe and effective treatment, (iv) to present the issues concerning radiobiological planning and the automation of the planning process.
Collapse
Affiliation(s)
| | | | | | - Christian Fiandra
- Dep. of Oncology Radiation Oncology Unit, University of Torino, Italy
| | | | | | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer, Institute IFO, Rome, Italy
| | | | - Michele Stasi
- Medical Physics Dept., Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Dept., Humanitas Clinical and Research Hospital, Rozzano (MI), Italy
| |
Collapse
|
26
|
Fitzgerald R, Owen R, Hargrave C, Pryor D, Lehman M, Bernard A, Mai T, Seshadri V, Fielding A. A Comparison of Non-coplanar Three-dimensional Conformal Radiation Therapy, Intensity Modulated Radiation Therapy, and Volumetric Modulated Radiation Therapy for the Delivery of Stereotactic Ablative Radiation Therapy to Peripheral Lung Cancer. J Med Imaging Radiat Sci 2017; 48:360-369. [PMID: 31047471 DOI: 10.1016/j.jmir.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/12/2017] [Accepted: 05/24/2017] [Indexed: 12/31/2022]
Abstract
AIM The objective of the study was to compare three noncoplanar delivery techniques (three-dimensional conformal radiation therapy [3DCRT], intensity-modulated radiation therapy [IMRT], and volumetric-modulated arc therapy [VMAT]) for the delivery of lung stereotactic ablative radiation therapy to peripheral lung tumours. METHODS AND MATERIALS The plans were compared by assessing the planning target volume coverage, doses to organs at risk, high and intermediate dose constraints (D2cm and R50%) and delivery times using analysis of variance for repeated measurements or Friedman's test when appropriate. RESULTS Mean PTV54 Gy coverage was found to be 95.6%, 95.7%, and 95.6% for the 3DCRT, IMRT, and VMAT techniques, respectively. No deviations to the intermediate dose constraints were found in 65%, 65%, and 85% of the patients for the 3DCRT, IMRT, and VMAT plans, respectively. Mean treatment times (excluding setup and imaging) were 20.0 minutes (±1.67), 25.2 minutes (±2.15), and 11.7 (±2.0) minutes respectively for 3DCRT, IMRT, and VMAT. CONCLUSION A noncoplanar VMAT technique was found to provide superior intermediate dose sparing with comparable prescription dose coverage when compared with noncoplanar 3DCRT or IMRT. In addition, VMAT was found to reduce the treatment times of stereotactic ablative radiation therapy delivery for peripheral lung tumours.
Collapse
Affiliation(s)
- Rhys Fitzgerald
- Icon Integrated Cancer Care Centre, Bundaberg, Queensland, Australia; Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Rebecca Owen
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Catriona Hargrave
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Radiation Oncology, Princess Alexandra Hospital, Raymond Tce, Queensland Health, Brisbane, Queensland, Australia
| | - David Pryor
- Radiation Oncology, Princess Alexandra Hospital, Ipswich Rd, Queensland Health, Brisbane, Queensland, Australia
| | - Margot Lehman
- Radiation Oncology, Princess Alexandra Hospital, Ipswich Rd, Queensland Health, Brisbane, Queensland, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Queensland, Australia
| | - Tao Mai
- Radiation Oncology, Princess Alexandra Hospital, Ipswich Rd, Queensland Health, Brisbane, Queensland, Australia
| | - Venkatakrishnan Seshadri
- Radiation Oncology, Princess Alexandra Hospital, Ipswich Rd, Queensland Health, Brisbane, Queensland, Australia
| | - Andrew Fielding
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
27
|
Ong CCH, Ang KW, Soh RCX, Tin KM, Yap JHH, Lee JCL, Bragg CM. Dosimetric comparison of peripheral NSCLC SBRT using Acuros XB and AAA calculation algorithms. Med Dosim 2017; 42:216-222. [PMID: 28711478 DOI: 10.1016/j.meddos.2017.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 11/19/2022]
Abstract
There is a concern for dose calculation in highly heterogenous environments such as the thorax region. This study compares the quality of treatment plans of peripheral non-small cell lung cancer (NSCLC) stereotactic body radiation therapy (SBRT) using 2 calculation algorithms, namely, Eclipse Anisotropic Analytical Algorithm (AAA) and Acuros External Beam (AXB), for 3-dimensional conformal radiation therapy (3DCRT) and volumetric-modulated arc therapy (VMAT). Four-dimensional computed tomography (4DCT) data from 20 anonymized patients were studied using Varian Eclipse planning system, AXB, and AAA version 10.0.28. A 3DCRT plan and a VMAT plan were generated using AAA and AXB with constant plan parameters for each patient. The prescription and dose constraints were benchmarked against Radiation Therapy Oncology Group (RTOG) 0915 protocol. Planning parameters of the plan were compared statistically using Mann-Whitney U tests. Results showed that 3DCRT and VMAT plans have a lower target coverage up to 8% when calculated using AXB as compared with AAA. The conformity index (CI) for AXB plans was 4.7% lower than AAA plans, but was closer to unity, which indicated better target conformity. AXB produced plans with global maximum doses which were, on average, 2% hotter than AAA plans. Both 3DCRT and VMAT plans were able to achieve D95%. VMAT plans were shown to be more conformal (CI = 1.01) and were at least 3.2% and 1.5% lower in terms of PTV maximum and mean dose, respectively. There was no statistically significant difference for doses received by organs at risk (OARs) regardless of calculation algorithms and treatment techniques. In general, the difference in tissue modeling for AXB and AAA algorithm is responsible for the dose distribution between the AXB and the AAA algorithms. The AXB VMAT plans could be used to benefit patients receiving peripheral NSCLC SBRT.
Collapse
Affiliation(s)
- Chloe C H Ong
- Faculty of Health and Wellbeing, Sheffield Hallam University, United Kingdom.
| | - Khong Wei Ang
- Division of Radiation Oncology, National Cancer Center Singapore, Singapore
| | - Roger C X Soh
- Division of Physics and Applied Physics, School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore
| | - Kah Ming Tin
- Division of Radiation Oncology, National Cancer Center Singapore, Singapore
| | - Jerome H H Yap
- Division of Radiation Oncology, National Cancer Center Singapore, Singapore
| | - James C L Lee
- Division of Radiation Oncology, National Cancer Center Singapore, Singapore; Division of Physics and Applied Physics, School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore
| | - Christopher M Bragg
- Faculty of Health and Wellbeing, Sheffield Hallam University, United Kingdom
| |
Collapse
|
28
|
Kang SW, Chung JB, Kim JS, Kim IA, Eom KY, Song C, Lee JW, Kim JY, Suh TS. Optimal planning strategy among various arc arrangements for prostate stereotactic body radiotherapy with volumetric modulated arc therapy technique. Radiol Oncol 2017; 51:112-120. [PMID: 28265240 PMCID: PMC5330172 DOI: 10.1515/raon-2017-0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/25/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the optimal strategy among various arc arrangements in prostate plans of stereotactic body radiotherapy with volumetric modulated arc therapy (SBRT-VMAT). PATIENTS AND METHODS To investigate how arc arrangements affect dosimetric and biological metrics, SBRT-VMAT plans for eighteen patients were generated with arrangements of single-full arc (1FA), single-partial arc (1PA), double-full arc (2FA), and double-partial arc (2PA). All plans were calculated by the Acuros XB calculation algorithm. Dosimetric and radiobiological metrics for target volumes and organs at risk (OARs) were evaluated from dosevolume histograms. RESULTS All plans were highly conformal (CI<1.05, CN=0.91) and homogeneous (HI=0.09-0.12) for target volumes. For OARs, there was no difference in the bladder dose, while there was a significant difference in the rectum and both femoral head doses. Plans using 1PA and 2PA showed a strong reduction to the mean rectum dose compared to plans using 1FA and 2FA. Contrastively, the D2% and mean dose in both femoral heads were always lower in plans using 1FA and 2FA. The average tumor control probability and normal tissue complication probability were comparable in plans using all arc arrangements. CONCLUSIONS The use of 1PA had a more effective delivery time and produced equivalent target coverage with better rectal sparing, although all plans using four arc arrangements showed generally similar for dosimetric and biological metrics. However, the D2% and mean dose in femoral heads increased slightly and remained within the tolerance. Therefore, this study suggests that the use of 1PA is an attractive choice for delivering prostate SBRT-VMAT.
Collapse
Affiliation(s)
- Sang Won Kang
- Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Beom Chung
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keun Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Changhoon Song
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Woo Lee
- Department of Radiation Oncology, Konkuk University Medical center, Seoul, Korea
| | - Jin Young Kim
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Tae Suk Suh
- Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
29
|
Sothmann T, Gauer T, Werner R. 4D dose simulation in volumetric arc therapy: Accuracy and affecting parameters. PLoS One 2017; 12:e0172810. [PMID: 28231337 PMCID: PMC5322962 DOI: 10.1371/journal.pone.0172810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/09/2017] [Indexed: 12/14/2022] Open
Abstract
Radiotherapy of lung and liver lesions has changed from normofractioned 3D-CRT to stereotactic treatment in a single or few fractions, often employing volumetric arc therapy (VMAT)-based techniques. Potential unintended interference of respiratory target motion and dynamically changing beam parameters during VMAT dose delivery motivates establishing 4D quality assurance (4D QA) procedures to assess appropriateness of generated VMAT treatment plans when taking into account patient-specific motion characteristics. Current approaches are motion phantom-based 4D QA and image-based 4D VMAT dose simulation. Whereas phantom-based 4D QA is usually restricted to a small number of measurements, the computational approaches allow simulating many motion scenarios. However, 4D VMAT dose simulation depends on various input parameters, influencing estimated doses along with mitigating simulation reliability. Thus, aiming at routine use of simulation-based 4D VMAT QA, the impact of such parameters as well as the overall accuracy of the 4D VMAT dose simulation has to be studied in detail–which is the topic of the present work. In detail, we introduce the principles of 4D VMAT dose simulation, identify influencing parameters and assess their impact on 4D dose simulation accuracy by comparison of simulated motion-affected dose distributions to corresponding dosimetric motion phantom measurements. Exploiting an ITV-based treatment planning approach, VMAT treatment plans were generated for a motion phantom and different motion scenarios (sinusoidal motion of different period/direction; regular/irregular motion). 4D VMAT dose simulation results and dose measurements were compared by local 3% / 3 mm γ-evaluation, with the measured dose distributions serving as ground truth. Overall γ-passing rates of simulations and dynamic measurements ranged from 97% to 100% (mean across all motion scenarios: 98% ± 1%); corresponding values for comparison of different day repeat measurements were between 98% and 100%. Parameters of major influence on 4D VMAT dose simulation accuracy were the degree of temporal discretization of the dose delivery process (the higher, the better) and correct alignment of the assumed breathing phases at the beginning of the dose measurements and simulations. Given the high γ-passing rates between simulated motion-affected doses and dynamic measurements, we consider the simulations to provide a reliable basis for assessment of VMAT motion effects that–in the sense of 4D QA of VMAT treatment plans–allows to verify target coverage in hypofractioned VMAT-based radiotherapy of moving targets. Remaining differences between measurements and simulations motivate, however, further detailed studies.
Collapse
Affiliation(s)
- Thilo Sothmann
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
- * E-mail:
| | - Tobias Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - René Werner
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| |
Collapse
|
30
|
Dosimetric effect of beam arrangement for intensity-modulated radiation therapy in the treatment of upper thoracic esophageal carcinoma. Med Dosim 2017; 42:47-52. [PMID: 28126472 DOI: 10.1016/j.meddos.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 02/05/2023]
Abstract
To evaluate the lung sparing in intensity-modulated radiation therapy (IMRT) for patients with upper thoracic esophageal tumors extending inferiorly to the thorax by different beam arrangement. Overall, 15 patient cases with cancer of upper thoracic esophagus were selected for a retrospective treatment-planning study. Intensity-modulated radiation therapy plans using 4, 5, and 7 beams (4B, 5B, and 7B) were developed for each patient by direct machine parameter optimization (DMPO). All plans were evaluated with respect to dose volumes to irradiated targets and normal structures, with statistical comparisons made between 4B with 5B and 7B intensity-modulated radiation therapy plans. Differences among plans were evaluated using a two-tailed Friedman test at a statistical significance of p < 0.05. The maximum dose, average dose, and the conformity index (CI) of planning target volume 1 (PTV1) were similar for 3 plans for each case. No significant difference of coverage for planning target volume 1 and maximum dose for spinal cords were observed among 3 plans in present study (p > 0.05). The average V5, V13, V20, mean lung dose, and generalized equivalent uniform dose (gEUD) for the total lung were significantly lower in 4B-plans than those data in 5B-plans and 7B-plans (p < 0.01). Although the average V30 for the total lung were significantly higher in 4B-plans than those in 5B-plans and 7B-plans (p < 0.05). In addition, when comparing with the 4B-plans, the conformity/heterogeneity index of the 5B- and 7B-plans were significantly superior (p < 0.05). The 4B-intensity-modulated radiation therapy plan has advantage to address the specialized problem of lung sparing to low- and intermediate-dose exposure in the thorax when dealing with relative long tumors extended inferiorly to the thoracic esophagus for upper esophageal carcinoma with the cost for less conformity. Studies are needed to compare the superiority of volumetric modulated arc therapy with intensity-modulated radiation therapy technique.
Collapse
|
31
|
Chin Snyder K, Kim J, Reding A, Fraser C, Gordon J, Ajlouni M, Movsas B, Chetty IJ. Development and evaluation of a clinical model for lung cancer patients using stereotactic body radiotherapy (SBRT) within a knowledge-based algorithm for treatment planning. J Appl Clin Med Phys 2016; 17:263-275. [PMID: 27929499 PMCID: PMC5690505 DOI: 10.1120/jacmp.v17i6.6429] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/15/2016] [Accepted: 08/14/2016] [Indexed: 12/03/2022] Open
Abstract
The purpose of this study was to describe the development of a clinical model for lung cancer patients treated with stereotactic body radiotherapy (SBRT) within a knowledge‐based algorithm for treatment planning, and to evaluate the model performance and applicability to different planning techniques, tumor locations, and beam arrangements. 105 SBRT plans for lung cancer patients previously treated at our institution were included in the development of the knowledge‐based model (KBM). The KBM was trained with a combination of IMRT, VMAT, and 3D CRT techniques. Model performance was validated with 25 cases, for both IMRT and VMAT. The full KBM encompassed lesions located centrally vs. peripherally (43:62), upper vs. lower (62:43), and anterior vs. posterior (60:45). Four separate sub‐KBMs were created based on tumor location. Results were compared with the full KBM to evaluate its robustness. Beam templates were used in conjunction with the optimizer to evaluate the model's ability to handle suboptimal beam placements. Dose differences to organs‐at‐risk (OAR) were evaluated between the plans generated by each KBM. Knowledge‐based plans (KBPs) were comparable to clinical plans with respect to target conformity and OAR doses. The KBPs resulted in a lower maximum spinal cord dose by 1.0±1.6Gy compared to clinical plans, p=0.007. Sub‐KBMs split according to tumor location did not produce significantly better DVH estimates compared to the full KBM. For central lesions, compared to the full KBM, the peripheral sub‐KBM resulted in lower dose to 0.035 cc and 5 cc of the esophagus, both by 0.4Gy±0.8Gy, p=0.025. For all lesions, compared to the full KBM, the posterior sub‐KBM resulted in higher dose to 0.035 cc, 0.35 cc, and 1.2 cc of the spinal cord by 0.2±0.4Gy, p=0.01. Plans using template beam arrangements met target and OAR criteria, with an increase noted in maximum heart dose (1.2±2.2Gy, p=0.01) and GI (0.2±0.4, p=0.01) for the nine‐field plans relative to KBPs planned with custom beam angles. A knowledge‐based model for lung SBRT consisting of multiple treatment modalities and lesion locations produced comparable plan quality to clinical plans. With proper training and validation, a robust KBM can be created that encompasses both IMRT and VMAT techniques, as well as different lesion locations. PACS number(s): 87.55de, 87.55kh, 87.53Ly
Collapse
|
32
|
Xhaferllari I, El-Sherif O, Gaede S. Comprehensive dosimetric planning comparison for early-stage, non-small cell lung cancer with SABR: fixed-beam IMRT versus VMAT versus TomoTherapy. J Appl Clin Med Phys 2016; 17:329-340. [PMID: 27685129 PMCID: PMC5874107 DOI: 10.1120/jacmp.v17i5.6291] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 06/07/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
Volumetric-modulated arc therapy (VMAT) is emerging as a leading technology in treating early-stage, non-small cell lung cancer (NSCLC) with stereotactic ablative radiotherapy (SABR). However, two other modalities capable of deliver-ing intensity-modulated radiation therapy (IMRT) include fixed-beam and helical TomoTherapy (HT). This study aims to provide an extensive dosimetric compari-son among these various IMRT techniques for treating early-stage NSCLC with SABR. Ten early-stage NSCLC patients were retrospectively optimized using three fixed-beam techniques via nine to eleven beams (high and low modulation step-and-shoot (SS), and sliding window (SW)), two VMAT techniques via two partial arcs (SmartArc (SA) and RapidArc (RA)), and three HT techniques via three different fan beam widths (1 cm, 2.5 cm, and 5 cm) for 80 plans total. Fixed-beam and VMAT plans were generated using flattening filter-free beams. SS and SA, HT treatment plans, and SW and RA were optimized using Pinnacle v9.1, Tomoplan v.3.1.1, and Eclipse (Acuros XB v11.3 algorithm), respectively. Dose-volume histogram statistics, dose conformality, and treatment delivery efficiency were analyzed. VMAT treatment plans achieved significantly lower values for contralat-eral lung V5Gy (p ≤ 0.05) compared to the HT plans, and significantly lower mean lung dose (p < 0.006) compared to HT 5 cm treatment plans. In the comparison between the VMAT techniques, a significant reduction in the total monitor units (p = 0.05) was found in the SA plans, while a significant decrease was observed in the dose falloff parameter, D2cm, (p = 0.05), for the RA treatments. The maximum cord dose was significantly reduced (p = 0.017) in grouped RA&SA plans com-pared to SS. Estimated treatment time was significantly higher for HT and fixed-beam plans compared to RA&SA (p < 0.001). Although, a significant difference was not observed in the RA vs. SA (p = 0.393). RA&SA outperformed HT in all parameters measured. Despite an increase in dose to the heart and bronchus, this study demonstrates that VMAT is dosimetrically advantageous in treating early-stage NSCLC with SABR compared to fixed-beam, while providing significantly shorter treatment times.
Collapse
|
33
|
Ishii K, Okada W, Ogino R, Kubo K, Kishimoto S, Nakahara R, Kawamorita R, Ishii Y, Tada T, Nakajima T. A treatment-planning comparison of three beam arrangement strategies for stereotactic body radiation therapy for centrally located lung tumors using volumetric-modulated arc therapy. JOURNAL OF RADIATION RESEARCH 2016; 57:273-279. [PMID: 26951076 PMCID: PMC4915539 DOI: 10.1093/jrr/rrv105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/08/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to determine appropriate beam arrangement for volumetric-modulated arc therapy (VMAT)-based stereotactic body radiation therapy (SBRT) in the treatment of patients with centrally located lung tumors. Fifteen consecutive patients with centrally located lung tumors treated at our institution were enrolled. For each patient, three VMAT plans were generated using two coplanar partial arcs (CP VMAT), two non-coplanar partial arcs (NCP VMAT), and one coplanar full arc (Full VMAT). All plans were designed to deliver 70 Gy in 10 fractions. Target coverage and sparing of organs at risk (OARs) were compared across techniques. PTV coverage was almost identical for all approaches. The whole lung V10Gy was significantly lower with CP VMAT plans than with NCP VMAT plans, whereas no significant differences in the mean lung dose, V5Gy, V20Gy or V40Gy were observed. Full VMAT increased mean contralateral lung V5Gy by 12.57% and 9.15% when compared with NCP VMAT and CP VMAT, respectively. Although NCP VMAT plans best achieved the dose-volume constraints for mediastinal OARs, the absolute differences in dose were small when compared with CP VMAT. These results suggest that partial-arc VMAT may be preferable to minimize unnecessary exposure to the contralateral lung, and use of NCP VMAT should be considered when the dose-volume constraints are not achieved by CP VMAT.
Collapse
Affiliation(s)
- Kentaro Ishii
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Wataru Okada
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryo Ogino
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Kazuki Kubo
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Shun Kishimoto
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryuta Nakahara
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryu Kawamorita
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Yoshie Ishii
- Department of Radiation Oncology, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan
| | - Takuhito Tada
- Department of Radiology, Izumi Municipal Hospital, 4-10-10 Futyu-cho, Izumi, 594-0071, Japan
| | - Toshifumi Nakajima
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| |
Collapse
|
34
|
Ghandour S, Cosinschi A, Mazouni Z, Pachoud M, Matzinger O. Optimization of stereotactic body radiotherapy treatment planning using a multicriteria optimization algorithm. Z Med Phys 2016; 26:362-370. [PMID: 27156924 DOI: 10.1016/j.zemedi.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To provide high-quality and efficient dosimetric planning for various types of stereotactic body radiotherapy (SBRT) for tumor treatment using a multicriteria optimization (MCO) technique fine-tuned with direct machine parameter optimization (DMPO). METHODS AND MATERIALS Eighteen patients with lung (n=11), liver (n=5) or adrenal cell cancer (n=2) were treated using SBRT in our clinic between December 2014 and June 2015. Plans were generated using the RayStation™ Treatment Planning System (TPS) with the VMAT technique. Optimal deliverable SBRT plans were first generated using an MCO algorithm to find a well-balanced tradeoff between tumor control and normal tissue sparing in an efficient treatment planning time. Then, the deliverable plan was post-processed using the MCO solution as the starting point for the DMPO algorithm to improve the dose gradient around the planning target volume (PTV) while maintaining the clinician's priorities. The dosimetric quality of the plans was evaluated using dose-volume histogram (DVH) parameters, which account for target coverage and the sparing of healthy tissue, as well as the CI100 and CI50 conformity indexes. RESULTS Using a combination of the MCO and DMPO algorithms showed that the treatment plans were clinically optimal and conformed to all organ risk dose volume constraints reported in the literature, with a computation time of approximately one hour. The coverage of the PTV (D99% and D95%) and sparing of organs at risk (OAR) were similar between the MCO and MCO+DMPO plans, with no significant differences (p>0.05) for all the SBRT plans. The average CI100 and CI50 values using MCO+DMPO were significantly better than those with MCO alone (p<0.05). CONCLUSIONS The MCO technique allows for convergence on an optimal solution for SBRT within an efficient planning time. The combination of the MCO and DMPO techniques yields a better dose gradient, especially for lung tumors.
Collapse
Affiliation(s)
- Sarah Ghandour
- Cancer Center - Radiotherapy Department, Riviera-Chablais Hospital, Vevey, Switzerland.
| | - Adrien Cosinschi
- Cancer Center - Radiotherapy Department, Riviera-Chablais Hospital, Vevey, Switzerland
| | - Zohra Mazouni
- Cancer Center - Radiotherapy Department, Riviera-Chablais Hospital, Vevey, Switzerland
| | - Marc Pachoud
- Cancer Center - Radiotherapy Department, Riviera-Chablais Hospital, Vevey, Switzerland
| | - Oscar Matzinger
- Cancer Center - Radiotherapy Department, Riviera-Chablais Hospital, Vevey, Switzerland
| |
Collapse
|
35
|
Cilla S, Deodato F, Macchia G, Digesù C, Ianiro A, Viola P, Craus M, Valentini V, Piermattei A, Morganti AG. Linac-based extracranial radiosurgery with Elekta volumetric modulated arc therapy and an anatomy-based treatment planning system: Feasibility and initial experience. Med Dosim 2016; 41:166-72. [DOI: 10.1016/j.meddos.2015.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 12/02/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
|
36
|
Lu JY, Zheng J, Zhang WZ, Huang BT. Flattening Filter-Free Beams in Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy for Sinonasal Cancer. PLoS One 2016; 11:e0146604. [PMID: 26734731 PMCID: PMC4703390 DOI: 10.1371/journal.pone.0146604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the dosimetric impacts of flattening filter-free (FFF) beams in intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for sinonasal cancer. METHODS For fourteen cases, IMRT and VMAT planning was performed using 6-MV photon beams with both conventional flattened and FFF modes. The four types of plans were compared in terms of target dose homogeneity and conformity, organ-at-risk (OAR) sparing, number of monitor units (MUs) per fraction, treatment time and pure beam-on time. RESULTS FFF beams led to comparable target dose homogeneity, conformity, increased number of MUs and lower doses to the spinal cord, brainstem and normal tissue, compared with flattened beams in both IMRT and VMAT. FFF beams in IMRT resulted in improvements by up to 5.4% for sparing of the contralateral optic structures, with shortened treatment time by 9.5%. However, FFF beams provided comparable overall OAR sparing and treatment time in VMAT. With FFF mode, VMAT yielded inferior homogeneity and superior conformity compared with IMRT, with comparable overall OAR sparing and significantly shorter treatment time. CONCLUSIONS Using FFF beams in IMRT and VMAT is feasible for the treatment of sinonasal cancer. Our results suggest that the delivery mode of FFF beams may play an encouraging role with better sparing of contralateral optic OARs and treatment efficiency in IMRT, but yield comparable results in VMAT.
Collapse
Affiliation(s)
- Jia-Yang Lu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jing Zheng
- Department of Laboratory, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, China
| | - Wu-Zhe Zhang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Bao-Tian Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- * E-mail:
| |
Collapse
|
37
|
Huang BT, Lin Z, Lin PX, Lu JY, Chen CZ. Monitor unit optimization in stereotactic body radiotherapy for small peripheral non-small cell lung cancer patients. Sci Rep 2015; 5:18453. [PMID: 26679747 PMCID: PMC4683452 DOI: 10.1038/srep18453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/18/2015] [Indexed: 02/05/2023] Open
Abstract
The increasingly attractive stereotactic body radiotherapy (SBRT) treatment for stage I lung cancer is concomitant with a large amount of monitor units (MU), leading to excessive out-of-field dose and prolonged beam-on time. The study aims to reduce the MU number and shorten the beam-on time by optimizing the planning parameters. Clinically acceptable treatment plans from fourteen patients suffered from peripheral stage I non-small cell lung cancer (NSCLC) were created in the study. Priority for the upper objective of the target (PUOT), strength and Max MU setting in the MU objective function (MUOF) were adjusted respectively to investigate their effect on MU number, organs at risk (OARs) sparing and beam-on time. We found that the planning parameters influenced the MU number in a PUOT, strength and Max MU dependent manner. Combined with high priority for the UOT (HPUOT) and MUOF, the MU number was reduced from 443 ± 25 to 228 ± 22 MU/Gy without compromising the target coverage and OARs sparing. We also found beam-on time was proportional to MU number and it could be shortened from 7.9 ± 0.5 to 4.1 ± 0.4 minutes.
Collapse
Affiliation(s)
- Bao-Tian Huang
- Cancer Hospital of Shantou University Medical College, Department of Radiation Oncology, Shantou, 515031, China
| | - Zhu Lin
- Cancer Hospital of Shantou University Medical College, Department of Radiation Oncology, Shantou, 515031, China
| | - Pei-Xian Lin
- The Second Affiliated Hospital of Shantou University Medical College, Department of Nosocomial Infection Management, Shantou, 515041, China
| | - Jia-Yang Lu
- Cancer Hospital of Shantou University Medical College, Department of Radiation Oncology, Shantou, 515031, China
| | - Chuang-Zhen Chen
- Cancer Hospital of Shantou University Medical College, Department of Radiation Oncology, Shantou, 515031, China
| |
Collapse
|
38
|
Intensity-modulated radiotherapy for lung cancer: current status and future developments. J Thorac Oncol 2015; 9:1598-608. [PMID: 25436795 DOI: 10.1097/jto.0000000000000346] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Radiotherapy plays an important role in the management of lung cancer, with over 50% of patients receiving this modality at some point during their treatment. Intensity-modulated radiotherapy (IMRT) is a technique that adds fluence modulation to beam shaping, which improves radiotherapy dose conformity around the tumor and spares surrounding normal structures. Treatment with IMRT is becoming more widely available for the treatment of lung cancer, despite the paucity of high level evidence supporting the routine use of this more resource intense and complex technique. In this review article, we have summarized data from planning and clinical studies, discussed challenges in implementing IMRT, and made recommendations on the minimum requirements for safe delivery of IMRT.
Collapse
|
39
|
Abstract
RapidArc™ is a radiation technique that delivers highly conformal dose distributions through the complete rotation (360°) and speed variation of the linear accelerator gantry. This technique, called volumetric modulated arc therapy (VMAT), compared with conventional radiotherapy techniques, can achieve high-target volume coverage and sparing damage to normal tissues. RapidArc delivers precise dose distribution and conformity similar to or greater than intensity-modulated radiation therapy in a short time, generally a few minutes, to which image-guided radiation therapy is added. RapidArc has become a currently used technology in many centers, which use RapidArc technology to treat a large number of patients. Large and small hospitals use it to treat the most challenging cases, but more and more frequently for the most common cancers. The clinical use of RapidArc and VMAT technology is constantly growing. At present, a limited number of clinical data are published, mostly concerning planning and feasibility studies. Clinical outcome data are increasing for a few tumor sites, even if only a little. The purpose of this work is to discuss the current status of VMAT techniques in clinical use through a review of the published data of planning systems and clinical outcomes in several tumor sites. The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, BioMed Central, and Scopus databases by searching for the keywords “RapidArc”, “Volumetric modulated arc radiotherapy”, and “Intensity-modulated radiotherapy”.
Collapse
Affiliation(s)
- Erminia Infusino
- Department of Radiotherapy, Campus Bio-Medico University Hospital, Rome, Italy
| |
Collapse
|
40
|
Chung JB, Kim JS, Eom KY, Kim IA, Kang SW, Lee JW, Kim JY, Suh TS. Comparison of VMAT-SABR treatment plans with flattening filter (FF) and flattening filter-free (FFF) beam for localized prostate cancer. J Appl Clin Med Phys 2015; 16:302–313. [PMID: 26699585 PMCID: PMC5691012 DOI: 10.1120/jacmp.v16i6.5728] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/04/2015] [Accepted: 07/27/2015] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study is to investigate the feasibility of using a flattening filter-free (FFF) beam with an endorectal balloon for stereotactic ablative body radiotherapy (SABR) of clinically localized prostate cancer. We assessed plans of SABR with volumetric-modulated arc therapy (VMAT) that used a flattening filter (FF) beam and an FFF beam and compared the verification results of dosimetric quality assurance for all pretreatment plans. A total of 20 patients with prostate cancer were enrolled in the study. SABR plans using VMAT with two full arcs were optimized in the Eclipse treatment planning system. All plans prescribed 42.7 Gy in 7 fractions of 6.1 Gy each. Four SABR plans were computed for each patient: two with FF beams and two with FFF beams of 6 and 10 MV. For all plans, the cumulative dose-volume histograms (DVHs) for the target volumes and organs at risk (OARs) were recorded and compared. Pretreatment quality assurance (QA) was performed using the I'mRT MatriXX system and radiochromic EBT3 film to verify treatment delivery, and gamma analysis was used to quantify the agreement between calculations and measurements. In addition, total monitor units (MUs) and delivery time were investigated as technical parameters of delivery. All four plans achieved adequate dose conformity to the target volumes and had comparable dosimetric data. The DVHs of all four plans for each patient were very similar. All plans were highly conformal with CI < 1.05 and CN > 0.90, and the doses were homogeneous (HI = 0.08-0.15). Sparing for the bladder and rectum was slightly better with the 10 MV FF and FFF plans than with the 6 MV FF and FFF plans, but the difference was negligible. However, there was no significant difference in sparing for the other OARs. The mean agreement with the 3%/3 mm criterion was higher than 97% for verifying all plans. For the 2%/2 mm criterion, the corresponding agreement values were more than 90%, which showed that the plans were acceptable. The mean MUs and delivery time used were 1701 ± 101 and 3.02 ± 0.17 min for 6 MV FF, 1870 ± 116 and 2.01 ± 0.01 min for 6 MV FFF, 1471 ± 86 and 2.68 ± 0.14 min for 10 MV FF, and 1619 ± 101 and 2.00 ± 0.00 min for 10MV FFF, respectively. In the current study, the dose distributions of the prostate SABR plans using 6 and 10 MV FFF beams were similar to those using 6 and 10 MV FF beams. However, this study confirmed that SABR treatment using an FFF beam had an advantage with respect to delivery time. In addition, all pretreatment plans were verified as acceptable and their results were comparable. Therefore, the results of this study suggest that the use of an FFF beam for prostate SABR is a feasible and efficient technique, if carefully applied.
Collapse
|
41
|
An IMRT/VMAT Technique for Nonsmall Cell Lung Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:613060. [PMID: 26539515 PMCID: PMC4619809 DOI: 10.1155/2015/613060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/13/2015] [Accepted: 07/21/2015] [Indexed: 01/22/2023]
Abstract
The study is to investigate a Hybrid IMRT/VMAT technique which combines intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for the treatment of nonsmall cell lung cancer (NSCLC). Two partial arcs VMAT, 5-field IMRT, and hybrid plans were created for 15 patients with NSCLC. The hybrid plans were combination of 2 partial arcs VMAT and 5-field IMRT. The dose distribution of planning target volume (PTV) and organs at risk (OARs) for hybrid technique was compared with IMRT and VMAT. The monitor units (MUs) and treatment delivery time were also evaluated. Hybrid technique significantly improved the target conformity and homogeneity compared with IMRT and VMAT. The mean delivery time of IMRT, VMAT, and hybrid plans was 280 s, 114 s, and 327 s, respectively. The mean MUs needed for IMRT, VMAT, and hybrid plans were 933, 512, and 737, respectively. Hybrid technique reduced V5, V10, V30, and MLD of normal lung compared with VMAT and spared the OARs better with fewer MUs with the cost of a little higher V5, V10, and mean lung dose (MLD) of normal lung compared with IMRT. Hybrid IMRT/VMAT can be a viable radiotherapy technique with better plan quality.
Collapse
|
42
|
Lee J, Kim JI, Ye SJ, Kim HJ, Carlson J, Park JM. Dosimetric effects of roll rotational setup errors on lung stereotactic ablative radiotherapy using volumetric modulated arc therapy. Br J Radiol 2015; 88:20140862. [PMID: 26369834 DOI: 10.1259/bjr.20140862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the dosimetric effects of roll-rotational setup errors of stereotactic ablative radiotherapy (SABR) for lung cancer using volumetric modulated arc therapy (VMAT). METHODS A total of 23 lung SABR cases were evaluated retrospectively. Each of the planning CT images was intentionally rotated by ±1°, ±2° and ±3°. After that, to simulate the translational couch correction, rotated CT images were moved along the x, y and z axis to match the centroid of the target volume in the rotated CT images with that in the original CT images. The differences in D95% and V100% of the target volume, D0.35cc of spinal cord, D0.35cc and D5cc of oesophagus and V20Gy of lung between the original and the rotated CT images were calculated. RESULTS The average differences in D95% and V100% of target volume, D0.35cc of spinal cord, D0.35cc and D5cc of oesophagus and V20Gy of lung were -0.3% ± 0.4% and -0.7% ± 2.4%, 1.6 ± 27.9 cGy, -1.6 ± 37.6 cGy, 15.9 ± 25.3 cGy and 0.0% ± 0.1%, respectively. The dosimetric changes in organs at risk (OARs) near the target volume were sometimes considerable due to roll-rotational setup errors, despite the translational correction, and those were patient specific. CONCLUSION In the case of coplanar VMAT for lung SABR, dosimetric changes to the target volume due to roll-rotational setup errors could be compensated by translational correction, whereas those to the OARs could not in some cases. ADVANCES IN KNOWLEDGE Roll-rotational setup errors would increase the dose to OARs despite the translational correction.
Collapse
Affiliation(s)
- Jaegi Lee
- 1 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Korea.,2 Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-In Kim
- 2 Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea.,3 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,4 Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,5 Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Korea
| | - Sung-Joon Ye
- 1 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Korea.,3 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Hak Jae Kim
- 3 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,4 Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,6 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Joel Carlson
- 1 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Korea.,2 Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Min Park
- 2 Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea.,3 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,4 Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,5 Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Korea
| |
Collapse
|
43
|
Subramanian SV, Subramani V, Thirumalai Swamy S, Gandhi A, Chilukuri S, Kathirvel M. Is 5 mm MMLC suitable for VMAT-based lung SBRT? A dosimetric comparison with 2.5 mm HDMLC using RTOG-0813 treatment planning criteria for both conventional and high-dose flattening filter-free photon beams. J Appl Clin Med Phys 2015. [PMID: 26219006 PMCID: PMC5690010 DOI: 10.1120/jacmp.v16i4.5415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of this study is to assess the suitability of 5 mm millennium multileaf collimator (MMLC) for volumetric‐modulated arc therapy (VMAT)‐based lung stereotactic body radiotherapy (SBRT). Thirty lung SBRT patient treatment plans along with their planning target volumes (ranging from 2.01 cc to 150.11 cc) were transferred to an inhomogeneous lung phantom and retrospectively planned using VMAT technique, along with the high definition multileaf collimator (HDMLC) and MMLC systems. The plans were evaluated using Radiation Therapy Oncology Group (RTOG‐0813) treatment planning criteria for target coverage, normal tissue sparing, and treatment efficiency for both the MMLC and HDMLC systems using flat and flattening filter‐free (FFF) photon beams. Irrespective of the target volumes, both the MLC systems were able to satisfy the RTOG‐0813 treatment planning criteria without having any major deviation. Dose conformity was marginally better with HDMLC. The average conformity index (CI) value was found to be 1.069±0.034 and 1.075±0.0380 for HDMLC and MMLC plans, respectively. For the 6 MV FFF beams, the plan was slightly more conformal, with the average CI values of 1.063±0.029 and 1.073±0.033 for the HDMLC and MMLC plans, respectively. The high dose spillage was the maximum for 2 cc volume set (3% for HDMLC and 3.1% for MMLC). In the case of low dose spillage, both the MLCs were within the protocol of no deviation, except for the 2 cc volume set. The results from this study revealed that VMAT‐based lung SBRT using 5 mm MMLC satisfies the RTOG‐0813 treatment planning criteria for the studied target size and shapes. PACS numbers: 87.53.Ly, 87.53D, 87.56.jk
Collapse
|
44
|
Dickey M, Roa W, Drodge S, Ghosh S, Murray B, Scrimger R, Gabos Z. A planning comparison of 3-dimensional conformal multiple static field, conformal arc, and volumetric modulated arc therapy for the delivery of stereotactic body radiotherapy for early stage lung cancer. Med Dosim 2015; 40:347-51. [PMID: 26027510 DOI: 10.1016/j.meddos.2015.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/13/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
The primary objective of this study was to compare dosimetric variables as well as treatment times of multiple static fields (MSFs), conformal arcs (CAs), and volumetric modulated arc therapy (VMAT) techniques for the treatment of early stage lung cancer using stereotactic body radiotherapy (SBRT). Treatments of 23 patients previously treated with MSF of 48Gy to 95% of the planning target volume (PTV) in 4 fractions were replanned using CA and VMAT techniques. Dosimetric parameters of the Radiation Therapy Oncology Group (RTOG) 0915 trial were evaluated, along with the van׳t Riet conformation number (CN), monitor units (MUs), and actual and calculated treatment times. Paired t-tests for noninferiority were used to compare the 3 techniques. CA had significant dosimetric improvements over MSF for the ratio of the prescription isodose volume to PTV (R100%, p < 0.0001), the maximum dose 2cm away from the PTV (D2cm, p = 0.005), and van׳t Riet CN (p < 0.0001). CA was not statistically inferior to MSF for the 50% prescription isodose volume to PTV (R50%, p = 0.05). VMAT was significantly better than CA for R100% (p < 0.0001), R50% (p < 0.0001), D2cm (p = 0.006), and CN (p < 0.0001). CA plans had significantly shorter treatment times than those of VMAT (p < 0.0001). Both CA and VMAT planning showed significant dosimetric improvements and shorter treatment times over those of MSF. VMAT showed the most favorable dosimetry of all 3 techniques; however, the dosimetric effect of tumor motion was not evaluated. CA plans were significantly faster to treat, and minimize the interplay of tumor motion and dynamic multileaf collimator (MLC) motion effects. Given these results, CA has become the treatment technique of choice at our facility.
Collapse
Affiliation(s)
- Mike Dickey
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Wilson Roa
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Suzanne Drodge
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Brad Murray
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Rufus Scrimger
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Zsolt Gabos
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada; Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada.
| |
Collapse
|
45
|
The importance of collimator angle error in volumetric-modulated arc therapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPurposeTo evaluate the dosimetric errors associated with the effect of the collimator angle error in volumetric-modulated arc therapy (VMAT) treatments.Methods and materialsFour patients with different planning target volume (PTV) and localisations treated using VMAT were analysed (high-risk prostate, low-risk prostate, head and neck (H&N) and holocranial with hippocampus protection) in terms of dosimetric variations when errors in the collimator angle were introduced. Original plans underwent modifications of the planned collimator angles of ±0·5°, ±1° and ±1·5°. These modified plans were re-calculated using the same original plan fluencies, and the resulting dose–volume histograms and homogeneity index (HI-ICRU) were compared.ResultsFor the high-risk prostate case, there was a noticeable loss of PTV dose coverage for collimator angle errors larger than ±1°, with HI-ICRU relative variations up to 75% in the range analysed. The low-risk prostate case did not present significant changes in organs at risk or PTV dose coverage. For the H&N case, the spinal cord presented changes around 4% forD0·1 cc. In the holocranial case, optic lens showed dose variations up to 5% for collimator angle errors larger than ±1°.ConclusionsThe effect of the collimator error in VMAT increased as the PTV increased.For selecting the position of the isocentre, one should be cautious, and whenever possible choose a position close to the geometrical centre of the PTVs in order to avoid or minimise errors from the calibration of the collimator angle.
Collapse
|
46
|
Sapkaroski D, Osborne C, Knight KA. A review of stereotactic body radiotherapy - is volumetric modulated arc therapy the answer? J Med Radiat Sci 2015; 62:142-51. [PMID: 26229679 PMCID: PMC4462986 DOI: 10.1002/jmrs.108] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 12/28/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is a high precision radiotherapy technique used for the treatment of small to moderate extra-cranial tumours. Early studies utilising SBRT have shown favourable outcomes. However, major disadvantages of static field SBRT include long treatment times and toxicity complications. Volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) may potentially mitigate these disadvantages. This review aims to assess the feasibility of emerging VMAT and IMRT-based SBRT treatment techniques and qualify which offers the best outcome for patients, whilst identifying any emerging and advantageous SBRT planning trends. A review and synthesis of data from current literature up to September 2013 was conducted on EMBASE, Medline, PubMed, Science Direct, Proquest central, Google Scholar and the Cochrane Database of Systematic reviews. Only full text papers comparing VMAT and or IMRT and or Static SBRT were included. Ten papers were identified that evaluated the results of VMAT/IMRT SBRT. Five related to medically inoperable stage 1 and 2 non-small-cell lung cancer (NSCLC), three to spinal metastasis, one related to abdominal lymph node malignancies, with the final one looking at pancreatic adenocarcinoma. Overall treatment times with VMAT were reduced by 66–70% for lung, 46–58% for spine, 42% and 21% for lymph node and pancreatic metastasis respectively, planning constraints were met with several studies showing improved organs at risk sparing with IMRT/VMAT to static SBRT. Both IMRT and VMAT were able to meet all planning constraints in the studies reviewed, with VMAT offering the greatest treatment efficiency. Early clinical outcomes with VMAT and IMRT SBRT have demonstrated excellent local control and favourable survival outcomes.
Collapse
Affiliation(s)
- Daniel Sapkaroski
- Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, School of Biomedical Sciences, Monash University Clayton, Vic., Australia
| | - Catherine Osborne
- Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, School of Biomedical Sciences, Monash University Clayton, Vic., Australia
| | - Kellie A Knight
- Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, School of Biomedical Sciences, Monash University Clayton, Vic., Australia
| |
Collapse
|
47
|
Huang BT, Lu JY, Lin PX, Chen JZ, Kuang Y, Chen CZ. Comparison of Two RapidArc Delivery Strategies in Stereotactic Body Radiotherapy of Peripheral Lung Cancer with Flattening Filter Free Beams. PLoS One 2015; 10:e0127501. [PMID: 26131554 PMCID: PMC4488574 DOI: 10.1371/journal.pone.0127501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/16/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate the performance of using partial arc (PA) and full arc with avoidance sectors (FAAS) in stereotactic body radiotherapy (SBRT) of peripheral lung cancer with flattening filter free (FFF) beams. METHODS Eighteen patients with primary (T1 or T2) non-small-cell lung cancer (NSCLC) or lung metastatic were selected for this study. Nine patients with a gross tumor volume (GTV) <= 10 cc were designated as the small tumor group. The other nine patients with a GTV between 10 cc and 44 cc were assigned to the large tumor group. The treatment plans were generated in eighteen patients using PA and FAAS techniques, respectively, and delivered with a Varian TrueBeam Linac. Dosimetry of the target and organs at risk (OARs), monitor unit (MU), out-of-field dose, and delivery time were statistically analyzed. Delta4 and portal dosimetry were employed to evaluate the delivery accuracy. RESULTS For the small tumor group, compared with the PA plans, the FAAS plans significantly achieved a lower MU/fraction, out-of-field dose and a shorter treatment time (p<0.05), but the target dose was slightly higher than that delivered by PA plans (p<0.05). For the large tumor group, the PA plans significantly attained a shorter treatment time (p<0.05), whereas MU/fraction, out-of-field dose and dose to OARs were comparable between the two plans (p>0.05). Furthermore, all plans generated from the eighteen patients achieved a high pass rate in patient-specific quality assurance, with all the gamma indices greater than 97% at the Γ3mm, 3% threshold. CONCLUSION This study suggests that the FAAS technique is more beneficial for the small tumor patients undergoing lung SBRT with FFF beams because of its higher treatment efficiency and MU reduction. However, for the large tumor patients, the PA technique is recommended due to its higher treatment efficiency.
Collapse
Affiliation(s)
- Bao-Tian Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jia-Yang Lu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Pei-Xian Lin
- Department of Nosocomial Infection Management, the Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jian-Zhou Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yu Kuang
- Medical Physics Program, University of Nevada Las Vegas, Las Vegas, NV, 89154, Unites States of America
| | - Chuang-Zhen Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- * E-mail:
| |
Collapse
|
48
|
de Figueiredo BH, Antoine M, Trouette R, Lagarde P, Petit A, Lamare F, Hatt M, Fernandez P. Use of FDG-PET to guide dose prescription heterogeneity in stereotactic body radiation therapy for lung cancers with volumetric modulated arc therapy: a feasibility study. Radiat Oncol 2014; 9:300. [PMID: 25534014 PMCID: PMC4300182 DOI: 10.1186/s13014-014-0300-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/14/2014] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to assess if FDG-PET could guide dose prescription heterogeneity and decrease arbitrary location of hotspots in SBRT. Methods For three patients with stage I lung cancer, a CT-simulation and a FDG-PET were registered to define respectively the PTVCT and the biological target volume (BTV). Two plans involving volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) were calculated. The first plan delivered 4 × 12 Gy within the PTVCT and the second plan, with SIB, 4 × 12 Gy and 13.8 Gy (115% of the prescribed dose) within the PTVCT and the BTV respectively. The Dmax-PTVCT had to be inferior to 60 Gy (125% of the prescribed dose). Plans were evaluated through the D95%, D99% and Dmax-PTVCT, the D2 cm, the R50% and R100% and the dice similarity coefficient (DSC) between the isodose 115% and BTV. DSC allows verifying the location of the 115% isodose (ideal value = 1). Results The mean PTVCT and BTV were 36.7 (±12.5) and 6.5 (±2.2) cm3 respectively. Both plans led to similar target coverage, same doses to the OARs and equivalent fall-off of the dose outside the PTVCT. On the other hand, the location of hotspots, evaluated through the DSC, was improved for the SIB plans with a mean DSC of 0.31 and 0.45 for the first and the second plans respectively. Conclusions Use of PET to decrease arbitrary location of hotspots is feasible with VMAT and SIB for lung cancer.
Collapse
|
49
|
Devereux T, Pham D, Kron T, Foroudi F, Supple J, Siva S. A planning study investigating dual-gated volumetric arc stereotactic treatment of primary renal cell carcinoma. Med Dosim 2014; 40:82-8. [PMID: 25498837 DOI: 10.1016/j.meddos.2014.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/27/2014] [Accepted: 11/04/2014] [Indexed: 12/25/2022]
Abstract
This is a planning study investigating the dosimetric advantages of gated volumetric-modulated arc therapy (VMAT) to the end-exhale and end-inhale breathing phases for patients undergoing stereotactic treatment of primary renal cell carcinoma. VMAT plans were developed from the end-inhale (VMATinh) and the end-exhale (VMATexh) phases of the breathing cycle as well as a VMAT plan and 3-dimensional conformal radiation therapy plan based on an internal target volume (ITV) (VMATitv). An additional VMAT plan was created by giving the respective gated VMAT plan a 50% weighting and summing the inhale and exhale plans together to create a summed gated plan. Dose to organs at risk (OARs) as well as comparison of intermediate and low-dose conformity was evaluated. There was no difference in the volume of healthy tissue receiving the prescribed dose for the planned target volume (PTV) (CI100%) for all the VMAT plans; however, the mean volume of healthy tissue receiving 50% of the prescribed dose for the PTV (CI50%) values were 4.7 (± 0.2), 4.6 (± 0.2), and 4.7 (± 0.6) for the VMATitv, VMATinh, and VMATexh plans, respectively. The VMAT plans based on the exhale and inhale breathing phases showed a 4.8% and 2.4% reduction in dose to 30cm(3) of the small bowel, respectively, compared with that of the ITV-based VMAT plan. The summed gated VMAT plans showed a 6.2% reduction in dose to 30cm(3) of the small bowel compared with that of the VMAT plans based on the ITV. Additionally, when compared with the inhale and the exhale VMAT plans, a 4% and 1.5%, respectively, reduction was observed. Gating VMAT was able to reduce the amount of prescribed, intermediate, and integral dose to healthy tissue when compared with VMAT plans based on an ITV. When summing the inhale and exhale plans together, dose to healthy tissue and OARs was optimized. However, gating VMAT plans would take longer to treat and is a factor that needs to be considered.
Collapse
Affiliation(s)
- Thomas Devereux
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Daniel Pham
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Australia
| | - Farshad Foroudi
- Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Australia; Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jeremy Supple
- School of Applied Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Australia; Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| |
Collapse
|
50
|
Intensity-modulated radiotherapy, not 3 dimensional conformal, is the preferred technique for treating locally advanced lung cancer. Semin Radiat Oncol 2014; 25:110-6. [PMID: 25771415 DOI: 10.1016/j.semradonc.2014.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
When used to treat lung cancer, intensity-modulated radiotherapy (IMRT) can deliver higher dose to the targets and spare more critical organs in lung cancer than can 3-dimensional conformal radiotherapy. However, tumor-motion management and optimized radiotherapy planning based on 4-dimensional computed tomography scanning are crucial to maximize the benefit of IMRT and to eliminate or minimize potential uncertainties. This article summarizes these strategies and reviews published findings supporting the safety and efficacy of IMRT for lung cancer.
Collapse
|