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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.
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Huang YY, Yang J, Liu YB. Planning issues on linac-based stereotactic radiotherapy. World J Clin Cases 2022; 10:12822-12836. [PMID: 36568990 PMCID: PMC9782937 DOI: 10.12998/wjcc.v10.i35.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
This work aims to summarize and evaluate the current planning progress based on the linear accelerator in stereotactic radiotherapy (SRT). The specific techniques include 3-dimensional conformal radiotherapy, dynamic conformal arc therapy, intensity-modulated radiotherapy, and volumetric-modulated arc therapy (VMAT). They are all designed to deliver higher doses to the target volume while reducing damage to normal tissues; among them, VMAT shows better prospects for application. This paper reviews and summarizes several issues on the planning of SRT to provide a reference for clinical application.
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Affiliation(s)
- Yang-Yang Huang
- School of Nuclear Science and Engineering, East China University of Technology, Nanchang 330013, Jiangxi Province, China
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Jun Yang
- Department of Radiotherapy, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yi-Bao Liu
- School of Nuclear Science and Engineering, East China University of Technology, Nanchang 330013, Jiangxi Province, China
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Ma M, Ren W, Li M, Niu C, Dai J. Dosimetric comparison of coplanar and noncoplanar beam arrangements for radiotherapy of patients with lung cancer: A meta-analysis. J Appl Clin Med Phys 2021; 22:34-43. [PMID: 33634946 PMCID: PMC8035566 DOI: 10.1002/acm2.13197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Radiotherapy plays an important role in the treatment of lung cancer, and both coplanar beam arrangements (CBA) and noncoplanar beam arrangements (NCBA) are adopted in clinic practice. The aim of this study is to answer the question whether NCBA are dosimetrically superior to CBA. Methods Search of publications were performed in PubMed, Web of Science, and the Cochran Library till March 2020. The searching terms were as following: ((noncoplanar) or ("non coplanar") or ("4pi") or ("4π")) AND (("lung cancer") or ("lung tumor") or ("lung carcinoma")) AND ((radiotherapy) or ("radiation therapy")). The included studies and extracted data were manually screened. All forest and funnel plots were carried out with RevMan software, and the Egger’s regression asymmetry tests were conducted with STATA software. Results Nine studies were included and evaluated in the meta‐analysis and treatment plans were designed with both CBA and NCBA. For the planning target volumes (PTV), D98%, D2%, the conformity index (CI), and the gradient index (GI) had no statistically significant difference. For organs‐at‐risk (OAR), V20 of the whole lung and the maximum dose of the spinal cord were significantly reduced in NCBA plans compared with CBA ones. But V10, V5, and mean dose of the whole lung, the maximum dose of the heart, and the maximum dose of the esophagus exhibited no significant difference when the two types of beam arrangements were compared. Conclusion After combining multicenter results, NCBA plans have significant advantages in reducing V20 of the whole lung and max dose of spinal cord.
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Affiliation(s)
- Min Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenting Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minghui Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuanmeng Niu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianrong Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kim ST, An HJ, Kim JI, Yoo JR, Kim HJ, Park JM. Non-coplanar VMAT plans for lung SABR to reduce dose to the heart: a planning study. Br J Radiol 2019; 93:20190596. [PMID: 31625759 DOI: 10.1259/bjr.20190596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to compare the plan quality of non-coplanar partial arc (NPA) volumetric modulated arc therapy (VMAT) to that of coplanar partial arc (CPA) VMAT for stereotactic ablative radiotherapy (SABR) for lung cancer. METHODS A total of 20 patients treated for lung cancer with the SABR VMAT technique and whose lung tumors were close to the heart were retrospectively selected for this study. For the CPA VMAT, three coplanar half arcs were used while two coplanar half arcs and one noncoplanar arc rotating 315°-45° with couch rotations of 315° ± 5° were used for the NPA VMAT. For each patient, identical CT image sets and identical structures were used for both the CPA and NPA VMAT plans. Dose-volumetric parameters of each plan were analyzed. RESULTS For the planning target volume and both lungs, no statistically significant differences between the CPA and NPA VMAT plans were observed in general. For the heart, average values of D0.1cc of the CPA and NPA VMAT plans were 29.42 ± 13.37 and 21.71 ± 9.20 Gy, respectively (p < 0.001). For whole body, the mean dose and the gradient index of the CPA VMAT plans were 1.2 ± 0.5 Gy and 4.356 ± 0.608 while those of the NPA VMAT plans were 1.1 ± 0.5 Gy and 4.111 ± 0.480, respectively (both with p < 0.001). CONCLUSION The NPA VMAT proposed in this study showed more favorable plan quality than the CPA VMAT plans for lung SABR with tumors located close to the heart. ADVANCES IN KNOWLEDGE For lung SABR, NPA VMAT can reduce doses to the heart as well as whole-body irradiation.
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Affiliation(s)
- Sang-Tae Kim
- Nuclear Emergency Division, Radiation Protection and Emergency Preparedness Bureau, Nuclear Safety and Security Commission, Seoul, Korea
| | - Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Biomedical Sciences, Seoul National University, Seoul, Korea
| | - Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jae-Ryong Yoo
- Radiation Emergency Medicine Regulation Team, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Robotics Research Laboratory for Extreme Environments, Advanced Institute of Convergence Technology, Suwon, Korea
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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.
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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
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