Forcing lateral electron disequilibrium to spare lung tissue: a novel technique for stereotactic body radiation therapy of lung cancer

Dose measurements in a thorax phantom at 3DCRT breast radiation therapy

Background

The anthropomorphic and anthropometric phantom developed by the research group NRI (Núcleo de Radiações Ionizantes) can reproduce the effects of the interactions of radiation occurring in the human body. The whole internal radiation transport phenomena can be depicted by film dosimeters in breast RT. Our goal was to provide a dosimetric comparison of a radiation therapy (RT) plan in a 4MV 3D-conformal RT (4MV-3DCR T) and experimental data measured in a breast phantom.

Materials and methods

The RT modality was two parallel opposing fields for the left breast with a prescribed dose of 2.0 Gy in 25 fractions. The therapy planning system (TPS) was performed on CA T3D software. The dose readings at points of interest (POI) pre-established in TPS were recorded. An anthropometric thorax-phantom with removal breast was used. EBT2 radiochromic films were inserted into the ipisilateral breast, contralateral breast, lungs, heart and skin. The irradiation was carried out on 4/80 Varian linear accelerator at 4MV.

Results

The mean dose at the OAR's presented statistically significant differences (p < 0.001) of 34.24%, 37.96% and 63.47% for ipsilateral lung, contralateral lung, and heart, respectively. The films placed at the skin-surface interface in the ipsilateral breast also showed statistically significant differences (p < 0.001) of 16.43%, -10.16%, -14.79% and 15.67% in the four quadrants, respectively. In contrast, the PTV dosimeters, representative of the left breast volume, encompassed by the electronic equilibrium, presented a non-significant difference with TPS, p = 0.20 and p = 0.90.

Conclusion

There was a non-significant difference of doses in PTV with electronic equilibrium; although no match is achieved outside electronic equilibrium.

Output factor determination based on Monte Carlo simulation for small cone field in 10-MV photon beam

The difficulty of measuring output factor (OPF) in a small field has been frequently discussed in recent publications. This study is aimed to determine the OPF in a small field using 10-MV photon beam and stereotactic conical collimator (cone). The OPF was measured by two diode detectors (SFD, EDGE detector) and one micro-ion chamber (PinPoint 3D chamber) in a water phantom. A Monte Carlo simulation using simplified detector model was performed to obtain the correction factor for the detector measurements. About 12% OPF difference was observed in the measurement at the smallest field (7.5 mm diameter) for EDGE detector and PinPoint 3D chamber. By applying the Monte Carlo-based correction factor to the measurement, the maximum discrepancy among the three detectors was reduced to within 3%. The results indicate that determination of OPF in a small field should be carefully performed. Especially, detector choice and appropriate correction factor application are very important in this regard.

Optimizing the prescription isodose level in stereotactic volumetric-modulated arc radiotherapy of lung lesions as a potential for dose de-escalation

BACKGROUND

To derive and exploit the optimal prescription isodose level (PIL) in inverse optimization of volumetric modulated arc radiotherapy (VMAT) as a potential approach to dose de-escalation in stereotactic body radiotherapy for non-small cell lung carcinomas (NSCLC).

METHODS

For ten patients, inverse Monte Carlo dose optimization was performed to cover 95% PTV by varying prescription isodose lines (PIL) at 60 to 80% and reference 85%. Subsequently, these were re-normalized to the median gross tumor volume dose (GTV-based prescription) to assess the impacts of PTV and normal tissue dose reduction.

RESULTS

With PTV-based prescription, GTV mean dose was much higher with the optimized PIL at 60% with significant reduction of normal lung receiving 30 to 10 Gy (V 30-10Gy ), and observable but insignificant dose reduction to spinal cord, esophagus, ribs, and others compared with 85% PIL. Mean doses to the normal lung between PTV and GTV was higher with 60-70% PIL than 85%. The dose gradient index was 5.0 ± 1.1 and 6.1 ± 1.4 for 60 and 85% PIL (p < 0.05), respectively. Compared with the reference 85% PIL plan using PTV-base prescription, significant decreases of all normal tissue doses were observed with 60% and 70% PIL by GTV-based prescription. Yet, the resulting biological effective (BED) mean doses of PTV remain sufficiently high, ranging 104.2 to 116.9 Gy α/β = 10.

CONCLUSIONS

Optimizing the PIL with VMAT has notable advantage of improving the dosimetric quality of lung SBRT and offers the potential of dose de-escalation for surrounding tissues while increasing the GTV dose simultaneously. The clinical implication of re-normalizing plans from PTV-prescription at 60-70% to the GTV median dose requires further investigations.

Dosimetric impact of gold markers implanted closely to lung tumors: a Monte Carlo simulation

We are developing an innovative dynamic tumor tracking irradiation technique using gold markers implanted around a tumor as a surrogate signal, a real‐time marker detection system, and a gimbaled X‐ray head in the Vero4DRT. The gold markers implanted in a normal organ will produce uncertainty in the dose calculation during treatment planning because the photon mass attenuation coefficient of a gold marker is much larger than that of normal tissue. The purpose of this study was to simulate the dose variation near the gold markers in a lung irradiated by a photon beam using the Monte Carlo method. First, the single‐beam and the opposing‐beam geometries were simulated using both water and lung phantoms. Subsequently, the relative dose profiles were calculated using a stereotactic body radiotherapy (SBRT) treatment plan for a lung cancer patient having gold markers along the anteriorposterior (AP) and right‐left (RL) directions. For the single beam, the dose at the gold marker‐phantom interface laterally along the perpendicular to the beam axis increased by a factor of 1.35 in the water phantom and 1.58 in the lung phantom, respectively. Furthermore, the entrance dose at the interface along the beam axis increased by a factor of 1.63 in the water phantom and 1.91 in the lung phantom, while the exit dose increased by a factor of 1.00 in the water phantom and 1.12 in the lung phantom, respectively. On the other hand, both dose escalations and dose de‐escalations were canceled by each beam for opposing portal beams with the same beam weight. For SBRT patient data, the dose at the gold marker edge located in the tumor increased by a factor of 1.30 in both AP and RL directions. In clinical cases, dose escalations were observed at the small area where the distance between a gold marker and the lung tumor was ≤ 5 mm, and it would be clinically negligible in multibeam treatments, although further investigation may be required.

PACS number: 87.10.Rt