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Köksal M, Özkan O, Holderried T, Heine A, Brossart P, Gawish A, Scafa D, Sarria GR, Leitzen C, Schmeel LC, Müdder T. Optimized Conformal Total Body Irradiation with VMAT Using a Linear-Accelerator-Based Radiosurgery Treatment System in Comparison to the Golden Standard Helical TomoTherapy. Cancers (Basel) 2023; 15:4220. [PMID: 37686498 PMCID: PMC10486387 DOI: 10.3390/cancers15174220] [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: 07/16/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Modern irradiation techniques for optimized conformal TBI can be realized by Helical Tomotherapy (HT) or Volumetric Modulated Arc Therapy (VMAT), depending on the availability of suitable specialized equipment. In this dosimetric planning study, we compared both modalities and addressed the question of whether VMAT with small field sizes is also suitable as a backup in case of HT equipment malfunctions. For this purpose, we retrospectively used planning computed tomography (CT) data from 10 patients treated with HT with a total dose of 8 Gy (n = 5) or 12 Gy (n = 5) for treatment planning for VMAT with a small field size (36 × 22 cm). The target volume coverage, dose homogeneity at target volume, and dose reduction in organs at risk (OAR) (lungs, kidneys, lenses) were analyzed and compared. One patient was irradiated with both modalities due to a device failure of the HT equipment during the study, which facilitated a comparison in a real clinical setting. The findings indicate that in addition to a higher mean dose to the lenses in the 12 Gy group for VMAT and a better dose homogeneity in the target volume for HT, comparably good and adequate target dose coverage and dose reduction in the other OAR could be achieved for both modalities, with significantly longer treatment times for VMAT. In conclusion, after appropriate optimization of the treatment times, VMAT using linear accelerator radiosurgery technology can be used both as a backup in addition to HT and in clinical routines to perform optimized conformal TBI.
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Affiliation(s)
- Mümtaz Köksal
- Department of Radiation Oncology, University Hospital of Bonn, 53127 Bonn, Germany
| | - Oğuzhan Özkan
- Department of Radiation Oncology, University Hospital of Bonn, 53127 Bonn, Germany
| | - Tobias Holderried
- Department of Internal Medicine—Oncology, Hematology and Rheumatology, University Hospital of Bonn, 53127 Bonn, Germany (P.B.)
| | - Annkristin Heine
- Department of Internal Medicine—Oncology, Hematology and Rheumatology, University Hospital of Bonn, 53127 Bonn, Germany (P.B.)
| | - Peter Brossart
- Department of Internal Medicine—Oncology, Hematology and Rheumatology, University Hospital of Bonn, 53127 Bonn, Germany (P.B.)
| | - Ahmed Gawish
- Department of Radiation Oncology, University Hospital of Marburg, 35043 Marburg, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital of Bonn, 53127 Bonn, Germany
| | - Gustavo R. Sarria
- Department of Radiation Oncology, University Hospital of Bonn, 53127 Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Hospital of Bonn, 53127 Bonn, Germany
| | - Leonard C. Schmeel
- Department of Radiation Oncology, University Hospital of Bonn, 53127 Bonn, Germany
| | - Thomas Müdder
- Department of Radiation Oncology, University Hospital of Bonn, 53127 Bonn, Germany
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Köksal M, Baumert J, Jazmati D, Schoroth F, Garbe S, Koch D, Scafa D, Sarria GR, Leitzen C, Massoth G, Delis A, Heine A, Holderried T, Brossart P, Müdder T, Schmeel LC. Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics. J Cancer Res Clin Oncol 2023; 149:7007-7015. [PMID: 36856852 PMCID: PMC10374741 DOI: 10.1007/s00432-023-04657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Intensity-modulated helical tomotherapy (HT) is a promising technique in preparation for bone marrow transplantation. Nevertheless, radiation-sensitive organs can be substantially compromised due to suboptimal delivery techniques of total body irradiation (TBI). To reduce the potential burden of radiation toxicity to organs at risk (OAR), high-quality coverage and homogeneity are essential. We investigated dosimetric data from kidney, lung and thorax, liver, and spleen in relation to peripheral blood kinetics. To further advance intensity-modulated total body irradiation (TBI), the potential for dose reduction to lung and kidney was considered in the analysis. PATIENTS AND METHODS 46 patients undergoing TBI were included in this analysis, partially divided into dose groups (2, 4, 8, and 12 Gy). HT was performed using a rotating gantry to ensuring optimal reduction of radiation to the lungs and kidneys and to provide optimal coverage of other OAR. Common dosimetric parameters, such as D05, D95, and D50, were calculated and analysed. Leukocytes, neutrophils, platelets, creatinine, GFR, haemoglobin, overall survival, and graft-versus-host disease were related to the dosimetric evaluation using statistical tests. RESULTS The mean D95 of the lung is 48.23%, less than half the prescribed and unreduced dose. The D95 of the chest is almost twice as high at 84.95%. Overall liver coverage values ranged from 96.79% for D95 to 107% for D05. The average dose sparing of all patients analysed resulted in an average D95 of 68.64% in the right kidney and 69.31% in the left kidney. Average D95 in the spleen was 94.28% and D05 was 107.05%. Homogeneity indexes ranged from 1.12 for liver to 2.28 for lung. The additional significance analyses conducted on these blood kinetics showed a significant difference between the 2 Gray group and the other three groups for leukocyte counts. Further statistical comparisons of the dose groups showed no significant differences. However, there were significant changes in the dose of OAR prescribed with dose sparing (e.g., lung vs. rib and kidney). CONCLUSION Using intensity-modulated helical tomotherapy to deliver TBI is a feasible method in preparation for haematopoietic stem cell transplantation. Significant dose sparing in radiosensitive organs such as the lungs and kidneys is achievable with good overall quality of coverage. Peripheral blood kinetics support the positive impact of HT and its advantages strongly encourage its implementation within clinical routine.
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Affiliation(s)
- Mümtaz Köksal
- Radiation Oncology, University Hospital Bonn, Bonn, Germany.
| | | | - Danny Jazmati
- Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Felix Schoroth
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Davide Scafa
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | | | - Gregor Massoth
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Achilles Delis
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Annkristin Heine
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Tobias Holderried
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Thomas Müdder
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
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Köksal M, Baumert J, Schoroth F, Scafa D, Koch D, Leitzen C, Sarria GR, Giordano FA, Chatzikonstantinou G, Schmeel LC. Lung sparing and ribcage coverage in total body irradiation delivered by helical tomotherapy. Eur J Med Res 2022; 27:287. [PMID: 36496388 PMCID: PMC9737733 DOI: 10.1186/s40001-022-00918-2] [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: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Helical tomotherapy (HT) is a viable method for delivering total body irradiation (TBI) when preparing patients for allogenic stem cell or bone-marrow transplantation. TBI can be planned to reduce the amount of radiation delivered to organs at risk, such as the lungs, with the aim of decreasing toxicity. However, it is important for the ribcage to receive the prescribed radiation dose in preparation for bone-marrow transplantation. In this retrospective study, we analyzed radiation dose coverage of the lungs and ribcage in patients who underwent TBI delivered by HT to achieve lung dose sparing. METHODS Thirty-five patients were included in the analysis and divided into three groups based on their prescribed radiation dose (4, 8, or 12 Gy). HT was performed using a rotating gantry to reduce radiation to the lungs. Dosimetric parameters for the lungs and ribcage as well as dose-volume histograms were calculated. RESULTS The mean lung D95 was 60.97%, 54.77%, and 37.44% of the prescribed dose for patients receiving 4 Gy, 8 Gy, and 12 Gy, respectively. Ribcage coverage was most optimal for patients receiving 4 Gy, with a D95 of 91.27% and mean homogeneity index of 1.17, whereas patients receiving 12 Gy had a mean D95 of 78.65% and homogeneity index of 1.37, which is still within the range recommended by treatment guidelines. CONCLUSIONS Using HT to achieve lung tissue sparing is a viable approach to minimizing pulmonic complications in patients undergoing TBI. As this planning adjustment does not compromise the dose and quality of coverage received by the ribcage, it is a feasible tool within conditioning regimens for allogeneic bone-marrow transplantation.
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Affiliation(s)
- Mümtaz Köksal
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Jonathan Baumert
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Felix Schoroth
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Davide Scafa
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Christina Leitzen
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Gustavo R. Sarria
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Frank A. Giordano
- grid.411778.c0000 0001 2162 1728Department of Radiation Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - Georgios Chatzikonstantinou
- grid.411088.40000 0004 0578 8220Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Leonard C. Schmeel
- grid.15090.3d0000 0000 8786 803XDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany
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