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Chen Q, Rong Y, Burmeister JW, Chao EH, Corradini NA, Followill DS, Li XA, Liu A, Qi XS, Shi H, Smilowitz JB. AAPM Task Group Report 306: Quality control and assurance for tomotherapy: An update to Task Group Report 148. Med Phys 2023; 50:e25-e52. [PMID: 36512742 DOI: 10.1002/mp.16150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/22/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Since the publication of AAPM Task Group (TG) 148 on quality assurance (QA) for helical tomotherapy, there have been many new developments on the tomotherapy platform involving treatment delivery, on-board imaging options, motion management, and treatment planning systems (TPSs). In response to a need for guidance on quality control (QC) and QA for these technologies, the AAPM Therapy Physics Committee commissioned TG 306 to review these changes and make recommendations related to these technology updates. The specific objectives of this TG were (1) to update, as needed, recommendations on tolerance limits, frequencies and QC/QA testing methodology in TG 148, (2) address the commissioning and necessary QA checks, as a supplement to Medical Physics Practice Guidelines (MPPG) with respect to tomotherapy TPS and (3) to provide risk-based recommendations on the new technology implemented clinically and treatment delivery workflow. Detailed recommendations on QA tests and their tolerance levels are provided for dynamic jaws, binary multileaf collimators, and Synchrony motion management. A subset of TPS commissioning and QA checks in MPPG 5.a. applicable to tomotherapy are recommended. In addition, failure mode and effects analysis has been conducted among TG members to obtain multi-institutional analysis on tomotherapy-related failure modes and their effect ranking.
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Affiliation(s)
- Quan Chen
- Radiation Oncology, City of Hope Medical Center, Duarte, California, USA
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic Hospitals, Phoenix, Arizona, USA
| | - Jay W Burmeister
- Karmanos Cancer Center, Gershenson R.O.C., Detroit, Michigan, USA
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | | | - David S Followill
- Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - X Allen Li
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - An Liu
- Radiation Oncology, City of Hope Medical Center, Duarte, California, USA
| | - X Sharon Qi
- Radiation Oncology, UCLA School of Medicine, Los Angeles, California, USA
| | - Hairong Shi
- Radiation Oncology, Oklahoma Cancer Specialists and Research Institute, Tulsa, Oklahoma, USA
| | - Jennifer B Smilowitz
- Human Oncology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Turcas A, Kelly SM, Clementel E, Cernea D. Tomotherapy for Cranio-Spinal Irradiation. Clin Transl Radiat Oncol 2022; 38:96-103. [PMID: 36407491 PMCID: PMC9672131 DOI: 10.1016/j.ctro.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/30/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022] Open
Abstract
Tomotherapy is safe and effective for cranio-spinal irradiation, both in paediatric patients and in adults, with similar disease-specific outcomes and toxicities as other techniques such as 3DCRT or IMRT/VMAT. Tomotherapy offers several technical advantages when compared to other radiotherapy techniques such as higher target conformity and better dose homogeneity. Helical Tomotherapy provides good organ-at-risk sparing for several structures, especially the vertebrae, parotids, and optic system. Reported treatment time/ beam-on-time is longer with helical Tomotherapy compared to other techniques.
Tomotherapy is a method of delivering rotational IMRT offering various advantages, notably for complex and large targets such as the cranio-spinal axis. This systematic literature review reports on main clinical outcomes and toxicities in patients with various cancer types that received whole craniospinal axis irradiation (CSI) using Tomotherapy and offers a comprehensive comparison between Tomotherapy and other radiotherapy delivery techniques. Databases including PubMed, PubMed Central, Embase, and Cochrane were searched using the keywords “tomotherapy” AND “craniospinal”. Fifty-six papers were included in the review. Patient population was adult in 9 papers, paediatric in 26 papers and mixed in 14 papers. Patients treated with helical Tomotherapy had similar disease-specific clinical outcomes and toxicities as patients treated using other techniques. Compared to any other technique, Tomotherapy provides better target coverage, homogeneity, and conformity in 23, 34 and 22 reports. Tomotherapy showed better organ-at-risk sparing for the thyroid, parotids, cochlea, eyes, heart and esophagus. Beam-On-Time (BOT) was reported to be longer for Tomotherapy in most studies (Median BOT: HT = 11 min, VMAT = 5.49 min, 3DCRT = 1.46 min). In conclusion, Tomotherapy offers good cranio-spinal axis coverage with improved homogeneity and conformity compared to other techniques, but with a considerably longer treatment time. Clinical outcome and toxicities suggest using Tomotherapy for CSI is efficient and safe.
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Practical aspects of the application of helical tomotherapy for craniospinal irradiation. Sci Rep 2021; 11:6120. [PMID: 33731843 PMCID: PMC7969733 DOI: 10.1038/s41598-021-85574-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022] Open
Abstract
We investigated the practical aspects of the application of craniospinal irradiation using helical tomotherapy (HT-CSI) by evaluating interfractional setup errors and intrafractional movement during each treatment in 83 patients undergoing HT-CSI between January 2014 and December 2018. Interfractional setup errors in each axis (mediolateral; ML, craniocaudal; CC, and anteroposterior; AP) were assessed as differences between pre-treatment megavoltage computed tomography (MVCT) images scanned (zygomatic arch to the C4 spine) and planning CT images. Intrafractional movements were evaluated as the difference between pre-treatment and post-treatment MVCT (T12–L4 spine) images at each fraction. Median interfractional setup error was acceptable in every axis (ML: 1.6 mm, CC: 1.9 mm, AP: 3.1 mm). Seven patients (8.4%) experienced significant intrafractional displacement from 1 to 10 fractions (0.34% for ML, 0.74% for CC, 1.21% for AP). Weight loss grade 1+ during treatment (p = 0.016) was an independent risk factor for significant intrafractional displacement. The risk factor for significant intrafractional movement in pediatric patients was weight loss grade 1+ (p = 0.020), while there was no factor in adults. HT-CSI could be a feasible treatment modality with acceptable setup verification. Inter- and intrafractional errors were acceptable; paying attention to weight loss during treatment is necessary, especially in pediatric patients.
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Öztunali A, Elsayad K, Scobioala S, Channaoui M, Haverkamp U, Grauer O, Sträter R, Brentrup A, Stummer W, Kerl K, Eich HT. Toxicity Reduction after Craniospinal Irradiation via Helical Tomotherapy in Patients with Medulloblastoma: A Unicentric Retrospective Analysis. Cancers (Basel) 2021; 13:cancers13030501. [PMID: 33525583 PMCID: PMC7865289 DOI: 10.3390/cancers13030501] [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: 12/23/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: Recent trials with craniospinal irradiation (CSI) via helical Tomotherapy (HT) demonstrated encouraging medulloblastoma results. In this study, we assess the toxicity profile of different radiation techniques and estimate survival rates. Materials and Methods: We reviewed the records of 46 patients who underwent irradiation for medulloblastoma between 1999 and 2019 (27 conventional radiotherapy technique (CRT) and 19 HT). Patient, tumor, and treatment characteristics, as well as treatment outcomes-local control rate (LCR), event-free survival (EFS), and overall survival (OS)-were reviewed. Acute and late adverse events (AEs) were evaluated according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results: In total, 43 courses of CSI and three local RT were administered to the 46 patients: 30 were male, the median age was 7 years (range 1-56). A median total RT dose of 55 Gy (range 44-68) and a median CSI dose of 35 Gy (range, 23.4-40) was delivered. During follow-up (median, 99 months), six patients (13%) developed recurrence. The EFS rate after 5 years was 84%. The overall OS rates after 5 and 10 years were 95% and 88%, respectively. There were no treatment-related deaths. Following HT, a trend towards lower grade 2/3 acute upper gastrointestinal (p = 0.07) and subacute CNS (p = 0.05) toxicity rates was detected compared to CRT-group. The risk of late CNS toxicities, mainly grade 2/3, was significantly lower following HT technique (p = 0.003). Conclusion: CSI via HT is an efficacious treatment modality in medulloblastoma patients. In all, we detected a reduced rate of several acute, subacute, and chronic toxicities following HT compared to CRT.
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Affiliation(s)
- Anil Öztunali
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
| | - Khaled Elsayad
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
- Correspondence: ; Tel.: +49-0-2518347384
| | - Sergiu Scobioala
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
| | - Mohammed Channaoui
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
| | - Uwe Haverkamp
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
| | - Oliver Grauer
- Neuro-Oncology Department, University Hospital Muenster, 48149 Muenster, Germany;
| | - Ronald Sträter
- Pediatric Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (R.S.); (K.K.)
| | - Angela Brentrup
- Department of Neurosurgery, University Hospital Muenster, 48149 Muenster, Germany; (A.B.); (W.S.)
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Muenster, 48149 Muenster, Germany; (A.B.); (W.S.)
| | - Kornelius Kerl
- Pediatric Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (R.S.); (K.K.)
| | - Hans Theodor Eich
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
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Pollul G, Bostel T, Grossmann S, Akbaba S, Karle H, Stockinger M, Schmidberger H. Pediatric craniospinal irradiation with a short partial-arc VMAT technique for medulloblastoma tumors in dosimetric comparison. Radiat Oncol 2020; 15:256. [PMID: 33153495 PMCID: PMC7643335 DOI: 10.1186/s13014-020-01690-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022] Open
Abstract
Background This study aimed to contrast four different irradiation methods for pediatric medulloblastoma tumors in a dosimetric comparison regarding planning target volume (PTV) coverage and sparing of organs at risk (OARs). Methods In sum 24 treatment plans for 6 pediatric patients were realized. Besides the clinical standard of a 3D-conformal radiotherapy (3D-CRT) treatment plan taken as a reference, volumetric modulated arc therapy (VMAT) treatment plans (“VMAT_AVD” vs. “noAVD” vs. “FullArc”) were optimized and calculated for each patient. For the thoracic and abdominal region, the short partial-arc VMAT_AVD technique uses an arc setup with reduced arc-length by 100°, using posterior and lateral beam entries. The noAVD uses a half 180° (posterior to lateral directions) and the FullArc uses a full 360° arc setup arrangement. The prescription dose was set to 35.2 Gy. Results We identified a more conformal dose coverage for PTVs and a better sparing of OARs with used VMAT methods. For VMAT_AVD mean dose reductions in organs at risk can be realized, from 16 to 6.6 Gy, from 27.1 to 8.7 Gy and from 8.0 to 1.9 Gy for the heart, the thyroid and the gonads respectively, compared to the 3D-CRT treatment method. In addition we have found out a superiority of VMAT_AVD compared to the noAVD and FullArc trials with lower exposure to low-dose radiation to the lungs and breasts. Conclusions With the short partial-arc VMAT_AVD technique, dose exposures to radiosensitive OARS like the heart, the thyroid or the gonads can be reduced and therefore, maybe the occurrence of late sequelae is less likely. Furthermore the PTV conformity is increased. The advantages of the VMAT_AVD have to be weighed against the potentially risks induced by an increased low dose exposure compared to the 3D-CRT method.
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Affiliation(s)
- Gerhard Pollul
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Tilman Bostel
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Sascha Grossmann
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Sati Akbaba
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Heiko Karle
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marcus Stockinger
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Lőcsei Z, Farkas R, Borbásné Farkas K, Sebestyén K, Sebestyén Z, Musch Z, Vojcek Á, Benedek N, Mangel L, Ottóffy G. Assessment of the results and hematological side effects of 3D conformal and IMRT/ARC therapies delivered during craniospinal irradiation of childhood tumors with a follow-up period of five years. BMC Cancer 2020; 20:702. [PMID: 32727407 PMCID: PMC7388493 DOI: 10.1186/s12885-020-07168-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/12/2020] [Indexed: 01/04/2023] Open
Abstract
Background Craniospinal irradiation (CSI) of childhood tumors with the RapidArc technique is a new method of treatment. Our objective was to compare the acute hematological toxicity pattern during 3D conformal radiotherapy with the application of the novel technique. Methods Data from patients treated between 2007 and 2014 were collected, and seven patients were identified in both treatment groups. After establishing a general linear model, acute blood toxicity results were obtained using SPSS software. Furthermore, the exposure dose of the organs at risk was compared. Patients were followed for a minimum of 5 years, and progression-free survival and overall survival data were assessed. Results After assessment of the laboratory parameters in the two groups, it may be concluded that no significant differences were detected in terms of the mean dose exposures of the normal tissues or the acute hematological side effects during the IMRT/ARC and 3D conformal treatments. Laboratory parameters decreased significantly compared to the baseline values during the treatment weeks. Nevertheless, no significant differences were detected between the two groups. No remarkable differences were confirmed between the two groups regarding the five-year progression-free survival or overall survival, and no signs of serious organ toxicity due to irradiation were observed during the follow-up period in either of the groups. Conclusion The RapidArc technique can be used safely even in the treatment of childhood tumors, as the extent of the exposure dose in normal tissues and the amount of acute hematological side effects are not higher with this technique.
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Affiliation(s)
- Zoltán Lőcsei
- Clinical Center, Department of Oncotherapy, University of Pécs, Édesanyák útja 17, Pécs, 7624, Hungary.
| | - Róbert Farkas
- Oncoradiology Center, Uzsoki Hospital, Uzsoki u. 29-41, Budapest, 1145, Hungary
| | - Kornélia Borbásné Farkas
- Unicersity of Pécs, Medical School, Institute of Bioanalysis, Szigeti út 12, Pécs, 7624, Hungary
| | - Klára Sebestyén
- Clinical Center, Department of Oncotherapy, University of Pécs, Édesanyák útja 17, Pécs, 7624, Hungary
| | - Zsolt Sebestyén
- Clinical Center, Department of Oncotherapy, University of Pécs, Édesanyák útja 17, Pécs, 7624, Hungary
| | - Zoltán Musch
- Clinical Center, Department of Oncotherapy, University of Pécs, Édesanyák útja 17, Pécs, 7624, Hungary
| | - Ágnes Vojcek
- Oncology Unit, Clinical Center, Department of Pediatrics Pécs, University of Pécs, József Attila út 7, Pécs, 7623, Hungary
| | - Noémi Benedek
- Oncology Unit, Clinical Center, Department of Pediatrics Pécs, University of Pécs, József Attila út 7, Pécs, 7623, Hungary
| | - László Mangel
- Clinical Center, Department of Oncotherapy, University of Pécs, Édesanyák útja 17, Pécs, 7624, Hungary
| | - Gábor Ottóffy
- Oncology Unit, Clinical Center, Department of Pediatrics Pécs, University of Pécs, József Attila út 7, Pécs, 7623, Hungary
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Dosimetric comparison of integral dose for different techniques of craniospinal irradiation. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000424] [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
AbstractAim:Comparison of the integral dose (ID) delivered to organs at risk (OAR), non-target body and target body by using different techniques of craniospinal irradiation (CSI).Materials and methods:Ten CSI patients (medulloblastoma) already planned and treated either with linear accelerator three-dimensional conformal radiation therapy (Linac-3DCRT) technique or with linear accelerator RapidArc (Linac-RapidArc) technique by Novalis-Tx Linac machine have been analysed. Retrospectively, these patients are again planned on Radixact-X9 Linac with Helical, Direct-3DCRT and Direct-intensity-modulated radiation therapy (Direct-IMRT) techniques. The dose prescription to planning target volume brain (PTV-Brain) and PTV-Spine is 36 Gy in 20 fractions and is kept the same for all techniques. The target body, non-target body, OARs and total body dose are compared.Results:ID is lowest in the RapidArc plan for every patient in comparison to Helical and Direct-IMRT. The ID for Body-PTV was found slightly higher in the RapidArc plan in comparison to 3DCRT plans. But there is better normal tissue sparing for most of the OARs in RapidArc plans if it compares with 3DCRT plans.Findings:RapidArc is a better alternative for the treatment of CSI. It provides better target coverage and better OARs sparing from any other treatment techniques.
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Liu M, Wei X, Ding Y, Cheng C, Yin W, Chen J, Wang K, Gu W. Application of Optical Laser 3D Surface imaging system (Sentinel) in breast cancer radiotherapy. Sci Rep 2020; 10:7550. [PMID: 32371862 PMCID: PMC7200723 DOI: 10.1038/s41598-020-64496-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/15/2020] [Indexed: 11/22/2022] Open
Abstract
It has been clearly confirmed that radiation therapy (RT) after breast conserving surgery (BCS) is an effective treatment modality comparable to mastectomy for early breast cancer. The purpose of this study was to further evaluate the accuracy of 3D surface imaging system (Sentinel) for breast cancer patients received BCS. The optical surface scans and CBCT scans were acquired before and immediately after couch movement correction. The deviation of the CBCT scans from the reference planning CT was considered an estimate for the residual errors for patient setup correction. The planning target volume (PTV) margins for treatment sessions was calculated according to the setup errors. We obtained a total of 245 sets of data collected from 49 breast cancer patients. Compared with Sentinel setup errors, the residual setup errors as determined by the CBCT scans after couch movement correction were reduced in the six directions. The PTV margins derived from the CBCT residual errors were all less than 5 mm in X, Y, and Z directions. Our results suggested that Optical surface imaging can be applied in positioning for breast cancer patient accurately without unnecessary imaging dose.
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Affiliation(s)
- Mengjiao Liu
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China
| | - Xiaobo Wei
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China
| | - Yun Ding
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China
| | - Changhai Cheng
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China
| | - Wenming Yin
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China
| | - Jie Chen
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China
| | - Kou Wang
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China
| | - Wendong Gu
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, 213003, People's Republic of China.
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A dosimetric comparison of craniospinal irradiation using TomoDirect radiotherapy, TomoHelical radiotherapy and 3D conventional radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396917000309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractAimThe purpose of this study was to dosimetrically compare TomoDirect, TomoHelical and linear accelerator-based 3D-conformal radiotherapy (Linac-3DCRT) for craniospinal irradiation (CSI) in the treatment of medulloblastoma.MethodsFive CSI patients were replanned with Linac-3DCRT, TomoHelical, TomoDirect-3DCRT and TomoDirect-intensity-modulated radiotherapy (IMRT). Dose of 36 Gy in 20 fractions was prescribed to the planning target volume (PTV). Homogeneity index (HI), non-target integral dose (NTID), dose–volume histograms, organs-at-risk (OARs)Dmax,Dmeanand treatment times were compared.ResultsTomoHelical achieved the best PTV homogeneity compared with Linac-3DCRT, TomoDirect-3DCRT and TomoDirect-IMRT (HI of 3·6 versus 20·9, 8·7 and 9·4%, respectively). TomoDirect-IMRT achieved the lowest NTID compared with TomoDirect-3DCRT, TomoHelical and Linac-3DCRT (141 J versus 151 J, 181 J and 250 J), indicating least biological damage to normal tissues. TomoHelical plans achieved the lowestDmaxin all organs except the breasts, and lowestDmeanfor most OARs, except in laterally situated OARs, where TomoDirect triumphed. Beam-on time was longest for TomoHelical, followed by TomoDirect and Linac-3DCRT.FindingsTomoDirect has the potential to lower NTID and shorten treatment times compared with TomoHelical. It reduces PTV inhomogeneity and better spares OARs compared with Linac-3DCRT. Therefore, TomoDirect may be a CSI treatment alternative to TomoHelical and in place of Linac-3DCRT.
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Abstract
PURPOSE Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) provide highly conformal target radiation doses, but also expose large volumes of healthy tissue to low-dose radiation. With improving survival, more children with medulloblastoma (MB) are at risk of late adverse effects of radiotherapy, including secondary cancers. We evaluated the characteristics of IMRT and VMAT craniospinal irradiation treatment plans in children with standard-risk MB to compare radiation dose delivery to target organs and organs at risk (OAR). PATIENTS AND METHODS Each of 10 children with standard-risk MB underwent both IMRT and VMAT treatment planning. Dose calculations used inverse planning optimization with a craniospinal dose of 23.4 Gy followed by a posterior fossa boost to 55.8 Gy. Clinical and planning target volumes were demarcated on axial computed tomography images. Dose distributions to target organs and OAR for each planning technique were measured and compared with published dose-volume toxicity data for pediatric patients. RESULTS All patients completed treatment planning for both techniques. Analyses and comparisons of dose distributions and dose-volume histograms for the planned target volumes, and dose delivery to the OAR for each technique demonstrated the following: (1) VMAT had a modest, but significantly better, planning target volume-dose coverage and homogeneity compared with IMRT; (2) there were different OAR dose-sparing profiles for IMRT versus VMAT; and (3) neither IMRT nor VMAT demonstrated dose reductions to the published pediatric dose limits for the eyes, the lens, the cochlea, the pituitary, and the brain. CONCLUSIONS The use of both IMRT and VMAT provides good target tissue coverage and sparing of the adjacent tissue for MB. Both techniques resulted in OAR dose delivery within published pediatric dose guidelines, except those mentioned above. Pediatric patients with standard-risk MB remain at risk for late endocrinologic, sensory (auditory and visual), and brain functional impairments.
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Salz H, Bohrisch B, Howitz S, Banz N, Weibert K, Wiezorek T, Wendt TG. Intensity-modulated Total Body Irradiation (TBI) with TomoDirect™. Radiat Oncol 2015; 10:58. [PMID: 25889227 PMCID: PMC4353674 DOI: 10.1186/s13014-015-0362-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 02/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The new TomoDirect™ modality offers a non-rotational option with discrete beam angles. We have investigated this mode for TBI with the intention to test the feasibility and to establish it as a clinical routine method. Special foci were directed onto treatment planning, dosimetric accuracy and practical aspects. PATIENTS AND METHODS TBI plans were calculated with TomoDirect™ for a Rando™ phantom and all patients with an intended fractionated total body irradiation between November 2013 and May 2014 (n = 8). Finally, four of these patients were irradiated with TomoDirect™. Additionally we studied variations in the modulation factor, pitch, field width of Y-jaws and dose grid during optimization. Dose measurements were performed using thermoluminescent rods in the Rando™ phantom, with the Delta4® and with ionization chambers in a solid water phantom. RESULTS For all eight calculated plans with a prescribed dose of 12 Gy Dmean was 12.09-12.33 Gy (12,25 ± 0.08 Gy), D98 11.2-11.6 Gy (11.45 ± 0.12 Gy) and D2 12.6-13.1 Gy (12.94 ± 0.13 Gy). Dmean of inner lungs was 8.73 ± 0.22 Gy on the left side and 8.69 ± 0.27 Gy on the right side. When single planning parameters are varied with otherwise constant parameters, the modulation factor showed the greatest impact on dose homogeneity and treatment time. The impact of the pitch was marginally, and almost equal homogeneity can be obtained with field width of Y-jaws 5 cm and 2.5 cm. Measurements with thermoluminescent rods (n = 25) in the Rando™ phantom showed a mean dose deviation between measured and calculated dose of 0.66 ± 2.26%. 18 of 25 TLDs had a deviation below 3%, seven of 25 TLDs between 3% and 5%. CONCLUSION TBI with TomoDirect™ allows a superior homogeneity compared to conventional methods, where lung blocks are widely accepted. The treatment is performed only in supine position and is robust and comfortable for the patient. TomoDirect™ allows the implementation of organ-specific dose prescriptions. So the discussion about the balance between the need for aggressive treatment and limited toxicity can be renewed with the new potentials of TomoDirect™ - for children as well as for adults - and possibly yield a better clinical outcome in the future.
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Affiliation(s)
- Henning Salz
- Department of Radiation Oncology, University Hospital Jena, Bachstr. 18, 07749, Jena, Germany.
| | - Babette Bohrisch
- Department of Radiation Oncology, University Hospital Jena, Bachstr. 18, 07749, Jena, Germany.
| | - Simon Howitz
- Department of Radiation Oncology, University Hospital Jena, Bachstr. 18, 07749, Jena, Germany.
| | - Nico Banz
- Department of Radiation Oncology, University Hospital Jena, Bachstr. 18, 07749, Jena, Germany.
| | - Kirsten Weibert
- Department of Radiation Oncology, University Hospital Jena, Bachstr. 18, 07749, Jena, Germany.
| | - Tilo Wiezorek
- Department of Radiation Oncology, University Hospital Jena, Bachstr. 18, 07749, Jena, Germany.
| | - Thomas G Wendt
- Department of Radiation Oncology, University Hospital Jena, Bachstr. 18, 07749, Jena, Germany.
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12
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Jung JH, Cho KH, Moon SK, Bae SH, Min CK, Kim ES, Yeo SG, Choi JH, Jung JY, Choe BY, Suh TS. Rotation Errors of Breast Cancer on 3D-CRT in TomoDirect. ACTA ACUST UNITED AC 2015. [DOI: 10.14316/pmp.2015.26.1.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jae Hong Jung
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, Korea
| | - Kwang Hwan Cho
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Seong Kwon Moon
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Sun Hyun Bae
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Chul Kee Min
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Eun Seog Kim
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Seung-Gu Yeo
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Jin Ho Choi
- Department of Radiation Oncology, Gachon University Gil Medical Center of Korea, Incheon, Korea
| | - Joo-Yong Jung
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, Korea
| | - Bo Young Choe
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, Korea
| | - Tae Suk Suh
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, Korea
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13
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Zhang X, Penagaricano J, Han EY, Morrill S, Hardee M, Liang X, Gupta SK, Corry PM, Ratanatharathom V. Dosimetric Comparison of Craniospinal Irradiation Using Different Tomotherapy Techniques. Technol Cancer Res Treat 2014; 14:440-6. [DOI: 10.1177/1533034614556932] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/08/2014] [Indexed: 11/15/2022] Open
Affiliation(s)
- X. Zhang
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J. Penagaricano
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E. Y. Han
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S. Morrill
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M. Hardee
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - X. Liang
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S. K. Gupta
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - P. M. Corry
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - V. Ratanatharathom
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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