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Nisha A, C S, Nagesh J, Nair SS. Comparison between Volumetric Modulated arc Therapy based Coplanar and Noncoplanar Planning for Stereotactic Body Radiation Therapy of Liver. Asian Pac J Cancer Prev 2024; 25:1383-1390. [PMID: 38680000 PMCID: PMC11162725 DOI: 10.31557/apjcp.2024.25.4.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/14/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND The study aims to investigate potential dosimetric benefits between non-coplanar and coplanar beam arrangements of Volumetric-Modulated Arc Therapy (VMAT) plans for liver stereotactic body radiotherapy (SBRT). METHODS Thirteen patients who had undergone liver SBRT treatment in our department were chosen retrospectively for the study. Two sets of SBRT-VMAT plans namely, non-coplanar (NC-VMAT) and Coplanar (C-VMAT) were generated in Monaco(v5.11) planning system for Elekta Versa HD Linac using unflatten 6MV photon. The NC-VMAT plans were created by two/three non-coplanar partial arcs with couch rotation of ±150 and had an arc span of 1300 to 1600 whereas the C-VMAT plans consisted of a full arc. Both plans were compared by statistically analyzing various dosimetric and technical parameters. RESULTS There is no statistically significant difference observed between the C-VMAT and NC-VMAT plans for planning target volume (PTV) coverage. However, the spine dose (D1cc) was much less in the NC-VMAT plan compared to the C-VMAT plan, with mean values of 6.127 ± 3.08Gy and 9.058 ± 4.76Gy, respectively (p-value=0.002). The low dose spillage to the healthy tissue was compared by the volume receiving 5Gy (V5Gy) and 10Gy (V10Gy). V5Gy of the NC-VMAT plan was 2399.23±1870.76cc while that of C-VMAT plans was 2835.36±1930.20cc with the p-value <0.001. Moreover, the monitor units(MU) were less with NC-VMAT than with C-VMAT SBRT plans (p=0.015). CONCLUSION The plan quality of NC-VMAT plans was favorable compared to C-VMAT plans for liver SBRT especially in reducing spine dose, low dose spillage to healthy tissue, and MU.
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Affiliation(s)
- Anjum Nisha
- Department of Radiotherapy and Oncology, Medical Radiation Physics Program, Manipal College of Health Professions(MCHP), Manipal Academy of Higher Education(MAHE), Manipal, Karnataka, India.
| | - Shambhavi C
- Department of Radiotherapy and Oncology, Medical Radiation Physics Program, Manipal College of Health Professions(MCHP), Manipal Academy of Higher Education(MAHE), Manipal, Karnataka, India.
| | - Jyothi Nagesh
- Radiotherapy and Oncology, Senior Grade Lecturer, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Sarath S Nair
- Radiotherapy and Oncology, Senior Grade Lecturer, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Loebner HA, Frauchiger D, Mueller S, Guyer G, Mackeprang PH, Stampanoni MFM, Fix MK, Manser P, Bertholet J. Technical note: Feasibility of gating for dynamic trajectory radiotherapy - Mechanical accuracy and dosimetric performance. Med Phys 2023; 50:6535-6542. [PMID: 37338935 DOI: 10.1002/mp.16533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/01/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Dynamic trajectory radiotherapy (DTRT) extends state-of-the-art volumetric modulated arc therapy (VMAT) by dynamic table and collimator rotations during beam-on. The effects of intrafraction motion during DTRT delivery are unknown, especially regarding the possible interplay between patient and machine motion with additional dynamic axes. PURPOSE To experimentally assess the technical feasibility and quantify the mechanical and dosimetric accuracy of respiratory gating during DTRT delivery. METHODS A DTRT and VMAT plan are created for a clinically motivated lung cancer case and delivered to a dosimetric motion phantom (MP) placed on the table of a TrueBeam system using Developer Mode. The MP reproduces four different 3D motion traces. Gating is triggered using an external marker block, placed on the MP. Mechanical accuracy and delivery time of the VMAT and DTRT deliveries with and without gating are extracted from the logfiles. Dosimetric performance is assessed by means of gamma evaluation (3% global/2 mm, 10% threshold). RESULTS The DTRT and VMAT plans are successfully delivered with and without gating for all motion traces. Mechanical accuracy is similar for all experiments with deviations <0.14° (gantry angle), <0.15° (table angle), <0.09° (collimator angle) and <0.08 mm (MLC leaf positions). For DTRT (VMAT), delivery times are 1.6-2.3 (1.6- 2.5) times longer with than without gating for all motion traces except one, where DTRT (VMAT) delivery is 5.0 (3.6) times longer due to a substantial uncorrected baseline drift affecting only DTRT delivery. Gamma passing rates with (without) gating for DTRT/VMAT were ≥96.7%/98.5% (≤88.3%/84.8%). For one VMAT arc without gating it was 99.6%. CONCLUSION Gating is successfully applied during DTRT delivery on a TrueBeam system for the first time. Mechanical accuracy is similar for VMAT and DTRT deliveries with and without gating. Gating substantially improved dosimetric performance for DTRT and VMAT.
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Affiliation(s)
- Hannes A Loebner
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Daniel Frauchiger
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Silvan Mueller
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Gian Guyer
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Paul-Henry Mackeprang
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Michael K Fix
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Mesny E, Ayadi M, Dupuis P, Beldjoudi G, Tanguy R, Martel-Lafay I. Clinical outcomes and lung toxicities after lung SABR using dynamic conformal arc therapy: a single-institution cohort study. Radiat Oncol 2023; 18:36. [PMID: 36814265 PMCID: PMC9948312 DOI: 10.1186/s13014-023-02227-2] [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: 01/23/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Stereotactic ablative radiotherapy (SABR) is a validated treatment for early stage lung cancer and pulmonary metastases. It provides a high local control rate with low symptomatic toxicities. Recently, Dynamic Conformal Arc Therapy (DCAT), a delivery option that differs from conventional DCA, has been implemented in the Monaco Treatment Planning System for SABR. The aim of the study was to report clinical outcomes and toxicities for patients treated for lung SABR with this new technique. METHODS We retrospectively identified adult patients treated for primary or secondary lung tumors with DCAT-SABR and reported their clinical, radiological, histological characteristics and dosimetric parameters. Total dose was delivered in 3 or 5 fractions for 95% of patients and prescribed on the 80% isodose line to the PTV periphery. RESULTS 145 patients met inclusion criteria for a total of 152 lesions with a median follow up of 12 months. Local control for the irradiated site was 96.7% at 1 year. Overall survival was 93.1% at 1 year. Mean prescription dose in BED10 was 110 Gy. 92% of patients had a prescribed dose superior to 100 Gy BED10. Mean PTV coverage was 95.1%. There were 66 cases of grade 1 radiation pneumonitis (RP) (43%) and only 7 cases of symptomatic grade 2 RP (4.6%). CONCLUSION Lung SABR for primary or metastatic lung tumors using dynamic conformal arc therapy provides efficient results of local control and low lung toxicities, similar to other SABR techniques. ADVANCES IN KNOWLEDGE SABR using DCAT is a safe technique to treat lung lesions, allowing intra-fraction motion limitation, potentially higher OARs protection and a shortened beam delivery.
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Affiliation(s)
- Emmanuel Mesny
- Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France.
| | - Myriam Ayadi
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Pauline Dupuis
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Guillaume Beldjoudi
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Ronan Tanguy
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Isabelle Martel-Lafay
- grid.418116.b0000 0001 0200 3174Service de Radiothérapie, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
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Kearney M, Keys M, Faivre-Finn C, Wang Z, Aznar MC, Duane F. Exposure of the heart in lung cancer radiation therapy: A systematic review of heart doses published during 2013 to 2020. Radiother Oncol 2022; 172:118-125. [PMID: 35577022 DOI: 10.1016/j.radonc.2022.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/26/2022] [Accepted: 05/08/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Lung cancer radiotherapy increases the risk of cardiotoxicity and heart radiation dose is an independent predictor of poor survival. This study describes heart doses and strategies aiming to reduce exposure. MATERIALS AND METHODS A systematic review of lung cancer dosimetry studies reporting heart doses published 2013-2020 was undertaken. Doses were compared according to laterality, region irradiated, treatment modality (stereotactic ablative body radiotherapy (SABR) and non-SABR), planning technique, and respiratory motion management. RESULTS For 392 non-SABR regimens in 105 studies, the average MHD was 10.3 Gy (0.0-48.4) and was not significantly different between left and right-sided tumours. It was similar between IMRT and 3DCRT (10.9 Gy versus 10.6 Gy) and lower with particle beam therapy (proton 7.0 Gy; carbon-ion 1.9 Gy). Active respiratory motion management reduced exposure (7.4 Gy versus 9.3 Gy). For 168 SABR regimens in 35 studies, MHD was 4.0 Gy (0.0-32.4). Exposure was higher in central and lower lobe lesions (6.3 and 5.8 Gy respectively). MHD was lowest for carbon ions (0.5 Gy) compared to other techniques. Active respiratory motion management reduced exposure (2.4 Gy versus 5.0 Gy). Delineation guidelines and Dose Volume Constraints for the heart varied substantially. CONCLUSIONS There is scope to reduce heart radiation dose in lung cancer radiotherapy. Consensus on planning objectives, contouring and DVCs for the heart may lead to reduced heart doses in the future. For IMRT, more stringent optimisation objectives may reduce heart dose. Active respiratory motion management or particle therapy may be considered in situations where cardiac dose is high.
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Affiliation(s)
- Maeve Kearney
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland.
| | - Maeve Keys
- St Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; The Christie NHS Foundation Trust, University of Manchester, United Kingdom
| | | | - Zhe Wang
- Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Marianne C Aznar
- Nuffield Department of Population Health, University of Oxford, United Kingdom; Manchester Cancer Research Centre, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Frances Duane
- St Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Ireland; Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland
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Modified VMAT Plans for Locally Advanced Centrally Located Non-Small Cell Lung Cancer (NSCLC). Life (Basel) 2021; 11:life11101085. [PMID: 34685456 PMCID: PMC8538695 DOI: 10.3390/life11101085] [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: 08/27/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives: This study aimed to find the optimal radiotherapy VMAT plans, that achieved high conformity and homogeneity to the planned target volume (PTV), and minimize the dose to nearby organs at risk including the non-PTV lung, heart and oesophagus for patients with centrally located non-small Cell Lung Cancer. Methods: A total of 18 patients who were treated for stage III centrally located non-small Cell Lung Cancer were selected retrospectively for this study. Identical CT datasets, 4D CT and structure dataset were used for radiotherapy planning based on single-planar VMAT (SP-VMAT), dual-planar VMAT (DP-VMAT) and Hybrid VMAT (H-VMAT). For SP-VMAT, one full arc and two half arcs were created on single-plane with couch at 0°. For DP-VMAT, one full arc was created with couch at 0°, and two half arcs with couch rotation of 330° or 30°. For H-VMAT, anterior-posterior opposing fixed beam and two half arcs were planned at couch at 0°. Dose constraints were adhered to the RTOG0617. Dose volumetric parameters were collected for statistical analysis. Results: There were no significant differences for the PTV, HI, CI between the SP-VMAT, DP-VMAT and H-VMAT. For the non-PTV lungs, Dmean, V20, V10, V5, D1500 and D1000 were significantly lower (2.05 Gy, 6.47%, 15.89%, 11.66% 4.17 Gy and 5.47 Gy respectively) in H-VMAT than that of SP-VMAT (all p < 0.001). For the oesophagus, Dmax, Dmean, V30 and V18.8 of H-VMAT were 0.08 Gy, 1.73 Gy, 5.54% and 7.17% lower than that of the SP-VMAT plan. For the heart, Dmean, V34, V28, V20 and V10 of DP-VMAT were lower than that of SP-VMAT by 1.45 Gy, 0.65%, 1.74%, 4.8% and 7.11% respectively. Conclusion: The proposed H-VMAT showed more favourable plan quality than the SP-VMAT for centrally located stage III NSCLC, in particular for non-PTV lungs and the oesophagus. It will benefit patients, especially those who planned for immunotherapy (Durvalumab) after standard chemo-irradiation. The proposed DP-VMAT plan showed significant dose reduction to the heart when compared to the H-VMAT plan.
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Gao L, Li C, Lu Z, Xie K, Lin T, Sui J, Ni X. Comparison of different treatment planning approaches using VMAT for head and neck cancer patients with metallic dental fillings. RADIATION MEDICINE AND PROTECTION 2021. [DOI: 10.1016/j.radmp.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lao Z, Bi F, Fan W, Xu X, Tu W, Shi H. Noncoplanar Versus Coplanar Intensity-Modulated Radiation Therapy (IMRT) for Protection of the Lip and Buccal Mucosa. Technol Cancer Res Treat 2021; 20:15330338211019511. [PMID: 34044671 PMCID: PMC8165526 DOI: 10.1177/15330338211019511] [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] [Indexed: 11/17/2022] Open
Abstract
Objective: In this study, by comparing coplanar and noncoplanar intensity-modulated radiation therapy (IMRT) treatment planning in treating tongue cancer, the significance of noncoplanar fields in the protection of the lip and buccal mucosa was determined, and a reasonable solution was selected. Methods: Forty-eight tongue cancer patients treated from June 2019 to February 2021 were selected and randomly divided into a coplanar field group and a noncoplanar field group. The mucosal dose limit changed from 15 Gy to 45 Gy for comparison of the two treatment plans. The evaluation indicators (conformal index (CI); homogeneity index (HI); D5, D50, and D98 of the target volume; and the dose of normal tissues) were calculated under different mucosal dose limits. The clinical observation of the lip and buccal mucosa of 48 cases was monitored and graded carefully according to NCI-CTCAE V4.0. Statistical analyses were performed. Results: The differences in CI, HI, D98, D50 and D5 between the two groups in the target volume tended to decrease when the mucosal dose limit was less than 30 Gy, with a significant difference (P < 0.05). When the limit exceeded 30 Gy, significant differences in other indicators except CI (P < 0.05) were still noted. In normal tissue, differences in doses between the two groups existed when the mucosal limit was less than 20 Gy, with a significant difference (P < 0.05). When the limit exceeded 20 Gy, no significant difference was noted. Patients in the noncoplanar group showed significantly better results than those in the other group in terms of the radiation-related toxicity of the lip and cheek membrane(P < 0.001). Conclusions: Compared with coplanar field radiotherapy, noncoplanar field radiotherapy can effectively reduce the exposure dose to the lip and buccal mucosa. The application of noncoplanar treatment plans exhibits good clinical significance and deserves to be promoted.
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Affiliation(s)
- Zheng Lao
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Fan Bi
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Wenhui Fan
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Xuanli Xu
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Wenyong Tu
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Huifeng Shi
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai 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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