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Naismith O, Mayles H, Bidmead M, Clark CH, Gulliford S, Hassan S, Khoo V, Roberts K, South C, Hall E, Dearnaley D. Radiotherapy Quality Assurance for the CHHiP Trial: Conventional Versus Hypofractionated High-Dose Intensity-Modulated Radiotherapy in Prostate Cancer. Clin Oncol (R Coll Radiol) 2019; 31:611-620. [PMID: 31201110 DOI: 10.1016/j.clon.2019.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
AIMS The CHHiP trial investigated the use of moderate hypofractionation for the treatment of localised prostate cancer using intensity-modulated radiotherapy (IMRT). A radiotherapy quality assurance programme was developed to assess compliance with treatment protocol and to audit treatment planning and dosimetry of IMRT. This paper considers the outcome and effectiveness of the programme. MATERIALS AND METHODS Quality assurance exercises included a pre-trial process document and planning benchmark cases, prospective case reviews and a dosimetry site visit on-trial and a post-trial feedback questionnaire. RESULTS In total, 41 centres completed the quality assurance programme (37 UK, four international) between 2005 and 2010. Centres used either forward-planned (field-in-field single phase) or inverse-planned IMRT (25 versus 17). For pre-trial quality assurance exercises, 7/41 (17%) centres had minor deviations in their radiotherapy processes; 45/82 (55%) benchmark plans had minor variations and 17/82 (21%) had major variations. One hundred prospective case reviews were completed for 38 centres. Seventy-one per cent required changes to clinical outlining pre-treatment (primarily prostate apex and base, seminal vesicles and penile bulb). Errors in treatment planning were reduced relative to pre-trial quality assurance results (49% minor and 6% major variations). Dosimetry audits were conducted for 32 centres. Ion chamber dose point measurements were within ±2.5% in the planning target volume and ±8% in the rectum. 28/36 films for combined fields passed gamma criterion 3%/3 mm and 11/15 of IMRT fluence film sets passed gamma criterion 4%/4 mm using a 98% tolerance. Post-trial feedback showed that trial participation was beneficial in evolving clinical practice and that the quality assurance programme helped some centres to implement and audit prostate IMRT. CONCLUSION Overall, quality assurance results were satisfactory and the CHHiP quality assurance programme contributed to the success of the trial by auditing radiotherapy treatment planning and protocol compliance. Quality assurance supported the introduction of IMRT in UK centres, giving additional confidence and external review of IMRT where it was a newly adopted technique.
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Affiliation(s)
- O Naismith
- Royal Marsden NHS Foundation Trust, London, UK.
| | - H Mayles
- Clatterbridge Cancer Centre, Bebington, Wirral, UK
| | - M Bidmead
- Royal Marsden NHS Foundation Trust, London, UK
| | - C H Clark
- Royal Surrey County Hospital, Guildford, UK
| | - S Gulliford
- The Institute of Cancer Research, London, UK
| | - S Hassan
- The Institute of Cancer Research, London, UK
| | - V Khoo
- Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - K Roberts
- Royal Marsden NHS Foundation Trust, London, UK
| | - C South
- Royal Surrey County Hospital, Guildford, UK
| | - E Hall
- The Institute of Cancer Research, London, UK
| | - D Dearnaley
- Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
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Radiotherapy of prostate cancer. Eur J Cancer 2011; 47 Suppl 3:S298-301. [DOI: 10.1016/s0959-8049(11)70178-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sia J, Joon DL, Viotto A, Mantle C, Quong G, Rolfo A, Wada M, Anderson N, Rolfo M, Khoo V. Toxicity and Long-Term Outcomes of Dose-Escalated Intensity Modulated Radiation Therapy to 74Gy for Localised Prostate Cancer in a Single Australian Centre. Cancers (Basel) 2011; 3:3419-31. [PMID: 24212961 PMCID: PMC3759203 DOI: 10.3390/cancers3033419] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/22/2022] Open
Abstract
Purpose To report the toxicity and long-term outcomes of dose-escalated intensity-modulated radiation therapy (IMRT) for patients with localised prostate cancer. Methods and Materials From 2001 to 2005, a total of 125 patients with histologically confirmed T1-3N0M0 prostate cancer were treated with IMRT to 74Gy at the Austin Health Radiation Oncology Centre. The median follow-up was 5.5 years (range 0.5–8.9 years). Biochemical prostate specific antigen (bPSA) failure was defined according to the Phoenix consensus definition (absolute nadir + 2ng/mL). Toxicity was scored according to the RTOG/EORTC criteria. Kaplan-Meier analysis was used to calculate toxicity rates, as well as the risks of bPSA failure, distant metastases, disease-specific and overall survival, at 5 and 8-years post treatment. Results All patients completed radiotherapy without any treatment breaks. The 8-year risks of ≥ Grade 2 genitourinary (GU) and gastrointestinal (GI) toxicity were 6.4% and 5.8% respectively, and the 8-year risks of ≥ Grade 3 GU and GI toxicity were both < 0.05%. The 5 and 8-year freedom from bPSA failure were 76% and 58% respectively. Disease-specific survival at 5 and 8 years were 95% and 91%, respectively, and overall survival at 5 and 8 years were 90% and 71%, respectively. Conclusions These results confirm existing international data regarding the safety and efficacy of dose-escalated intensity-modulated radiation therapy for localised prostate cancer within an Australian setting.
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Affiliation(s)
- Joseph Sia
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Daryl Lim Joon
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Angela Viotto
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Carmel Mantle
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - George Quong
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
- Radiation Oncology Victoria, East Melbourne, Victoria 3002, Australia
| | - Aldo Rolfo
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
- Radiation Oncology Victoria, East Melbourne, Victoria 3002, Australia
| | - Morikatsu Wada
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Nigel Anderson
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Maureen Rolfo
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Vincent Khoo
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
- Department of Medicine, University of Melbourne, Melbourne Victoria 3053, Australia
- Royal Marsden Hospital & Institute of Cancer Research, London SW3 6JJ, UK
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-3-9496 2800; Fax: +61-3-9496 2826
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Comparaison dosimétrique de trois balistiques prostatiques : radiothérapie conformationnelle tridimensionnelle, arcthérapie coplanaire et arcthérapie non-coplanaire. Cancer Radiother 2008; 12:343-51. [DOI: 10.1016/j.canrad.2007.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/12/2007] [Accepted: 12/26/2007] [Indexed: 11/18/2022]
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Streszczenie. Rep Pract Oncol Radiother 2007. [DOI: 10.1016/s1507-1367(07)70955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Pavel-Mititean LM, Rowbottom CG, Hector CL, Partridge M, Bortfeld T, Schlegel W. A geometric model for evaluating the effects of inter-fraction rectal motion during prostate radiotherapy. Phys Med Biol 2005; 49:2613-29. [PMID: 15272677 DOI: 10.1088/0031-9155/49/12/010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A geometric model is presented which allows calculation of the dosimetric consequences of rectal motion in prostate radiotherapy. Variations in the position of the rectum are measured by repeat CT scanning during the courses of treatment of five patients. Dose distributions are calculated by applying the same conformal treatment plan to each imaged fraction and rectal dose-surface histograms produced. The 2D model allows isotropic expansion and contraction in the plane of each CT slice. By summing the dose to specific volume elements tracked by the model, composite dose distributions are produced that explicitly include measured inter-fraction motion for each patient. These are then used to estimate effective dose-surface histograms (DSHs) for the entire treatment. Results are presented showing the magnitudes of the measured target and rectal motion and showing the effects of this motion on the integral dose to the rectum. The possibility of using such information to calculate normal tissue complication probabilities (NTCP) is demonstrated and discussed.
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Bauman G, Gete E, Chen JZ, Wong E. Simplified intensity-modulated arc therapy for dose escalated prostate cancer radiotherapy. Med Dosim 2004; 29:18-25. [PMID: 15023389 DOI: 10.1016/j.meddos.2003.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2003] [Accepted: 09/20/2003] [Indexed: 11/25/2022]
Abstract
Simplified intensity-modulated arc therapy (SIMAT) employs forward planned, conformal, and avoidance arc combinations with dynamic multileaf collimation (MLC) as a simpler alternative to other forms of intensity-modulated radiotherapy (IMRT). In this work, we compare SIMAT with 4-field (4F) and 6-field (6F) 3D conformal radiation therapy (CRT) for prostate cancer treatment. Prostate, seminal vesicle, bladder, and rectum were contoured on the CT images of 10 patients being planned for radiotherapy. Two planning target volumes (PTV) were defined: PTV1 (prostate + seminal vesicles + 1.0-cm margin) and PTV2 (prostate + 1.0-cm margin). SIMAT, 4F, and 6F plans were generated with a prescription dose of 78 Gy to prostate and 54 Gy to the seminal vesicles. Differences in the 3 techniques in terms of target and rectal coverage were compared. In addition, dose distributions of the SIMAT plans were verified with measurements in a phantom. Mean dose to PTV2 (4F, 76 Gy; 6F, 78 Gy; SIMAT, 76 Gy) and the dose delivered to 95% of the target volume (D(95)) were similar between the 3-techniques. Target conformity was better with SIMAT. Mean dose and calculated NTCP for the rectum were lower for SIMAT than those for 4F and 6F plans (4F 55.6 Gy vs. 6F 49.0 Gy vs. SIMAT 42.7 Gy). Mean dose to femoral heads was lower for the 4F technique vs. 6F and SIMAT techniques (4F 44.5 Gy vs. 6F 48.9 Gy vs. SIMAT 49.5 Gy). In-phantom measurement demonstrated good agreement between the plans and SIMAT treatments delivered in phantom. We concluded that SIMAT demonstrates advantages over 4F and 6F in terms of target conformity mean rectal dose and NTCP with good reproducibility in phantom. On the basis of this analysis, we have commenced a clinical pilot study of SIMAT for prostate cancer radiotherapy.
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Affiliation(s)
- G Bauman
- Departments of Radiation Oncology, London Regional Cancer Centre and the University of Western Ontario, London, Ontario, Canada.
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Bedford JL, Webb S. Elimination of importance factors for clinically accurate selection of beam orientations, beam weights and wedge angles in conformal radiation therapy. Med Phys 2003; 30:1788-804. [PMID: 12906197 DOI: 10.1118/1.1582471] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A method of simultaneously optimizing beam orientations, beam weights, and wedge angles for conformal radiotherapy is presented. This method removes the need for importance factors by optimizing one objective only, subject to a set of rigid constraints. This facilitates the production of inverse solutions which, without trial-and-error modification of importance factors, precisely satisfy the specified constraints. The algorithm minimizes an objective function which is based upon the single objective to be optimized, but which is forced to an artificially high value when the constraints are not met, so that only satisfactory solutions are allowed. Due to the complex nature of the objective function space, including multiple local minima separated by large regions of plateau, a random search technique equivalent to fast simulated annealing is used for producing inverse plans. To illustrate the novel features of the new algorithm, a simulation is first presented, for the case of a cylindrical phantom. The morphology of the objective function space is shown to be significantly different for the new algorithm, compared to that for a conventional quadratic objective function. Clinical cases for prostate and craniopharyngioma are then presented. For the prostate case, the objective is to reduce irradiated rectal volume. Three-field, four-field, and six-field optimizations, with or without orientation optimization, are shown to provide solutions which are consistent with previously reported plans and class solutions. For the craniopharyngioma case, which involves the use of a high-precision stereotactic conformal technique, the objective is to reduce the irradiated volume of normal brain. Practically feasible beam angles are produced which, compared to a standard plan, provide a small but worthwhile sparing of normal brain. The algorithm is thereby shown to be robust and suitable for clinical application.
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Affiliation(s)
- James L Bedford
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
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Khoo VS, Bedford JL, Webb S, Dearnaley DP. Class solutions for conformal external beam prostate radiotherapy. Int J Radiat Oncol Biol Phys 2003; 55:1109-20. [PMID: 12605991 DOI: 10.1016/s0360-3016(02)04393-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine a class solution coplanar plan from comparisons of three-field (3F), four-field (4F), and six-field (6F) plans in conformal non-intensity-modulated prostate radiotherapy. METHODS AND MATERIALS Doses to two clinical target volumes, prostate only (PO) and prostate plus seminal vesicles (PSV) were evaluated in each of 10 patients using a variety of 3F, 4F, and 6F plans with a planning target volume margin of 10 mm. All plans were prescribed to 64 and 74 Gy. The class solution plan for each of 3F, 4F, and 6F was chosen from a variety of symmetrical and asymmetrical field arrangements that had been previously assessed. The class solution plans, 3F (0, 90, 270 degrees ), 4F (35, 90, 270, 325 degrees ), and 6F (50/lat/25) were compared with reference plans: 3F (0, 120, 240 degrees ), 4F (0, 90, 180, 270 degrees ), and 6F (55, 90, 125, 235, 270, 305 degrees ). Rectal volumes irradiated to greater than 50% (V(50)), 80% (V(80)), and 90% (V(90)) of the prescribed dose, normal tissue complication probabilities (NTCP) for rectum, bladder, and femoral heads (FH), and tumor control probabilities (TCP) were assessed. FH tolerance was set at 52 Gy to 10% volume. RESULTS The field arrangement that gave the lowest irradiated rectal volume with acceptable bladder and FH doses was a 3F (0, 90, 270 degrees ) class solution plan. This plan gave a reduction in rectal V(80) of 1.2-12.4% for the PO group and 2.3-23.8% for the PSV group compared with the other plans. The reduction in rectal V(90) was 0.2-11.9% for the PO group and 1.5-23.3% for the PSV group using the 3F (0, 90, 270 degrees ) plan. This plan provided one of the lowest rectal NTCPs, but the difference was not significant when compared with the 4F class solution plan. When target volumes with 10-mm margins remain unchanged to 74 Gy, the irradiated rectal volumes for all plans were higher and rectal NTCPs can be trebled. CONCLUSION The use of appropriate beam arrangements can provide a class solution plan using only 3 fields compared with 4 or 6 fields for the parameters considered. Both 3F (0, 90, 270 degrees ) and 4F (35, 90, 270, 325 degrees ) plans can be used as a class solution plan. Other practical issues that may influence the choice of class solution include delivery time with smaller number of fields, ease of verification, the use of 10-mm multileaf collimation vs. conformal blocks, and field shape fitting limitations when using dynamic wedges.
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Affiliation(s)
- Vincent S Khoo
- Academic Unit of Radiotherapy and Oncology, Sutton, Surrey, United Kingdom.
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Corletto D, Iori M, Paiusco M, Brait L, Broggi S, Ceresoli G, Iotti C, Calandrino R, Fiorino C. Inverse and forward optimization of one- and two-dimensional intensity-modulated radiation therapy-based treatment of concave-shaped planning target volumes: the case of prostate cancer. Radiother Oncol 2003; 66:185-95. [PMID: 12648791 DOI: 10.1016/s0167-8140(02)00375-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) was suggested as a suitable technique to protect the rectal wall, while maintaining a satisfactory planning target volume (PTV) irradiation in the case of high-dose radiotherapy of prostate cancer. However, up to now, few investigations tried to estimate the expected benefit with respect to conventional three-dimensional (3D) conformal radiotherapy (CRT). PURPOSE Estimating the expected clinical gain coming from both 1D and 2D IMRT against 3DCRT, in the case of prostate cancer by mean of radiobiological models. In order to enhance the impact of IMRT, the case of concave-shaped PTV including prostate and seminal vesicles (P+SV) was considered. MATERIALS AND METHODS Five patients with concave-shaped PTV including P+SV were selected. Two different sets of constraints were applied during planning: in the first one a quite large inhomogeneity of the dose distribution within the PTV was accepted (set (a)); in the other set (set (b)) a greater homogeneity was required. Tumor control probability (TCP) and normal tissue control probability (NTCP) indices were calculated through the Webb-Nahum and the Lyman-Kutcher models, respectively. Considering a dose interval from 64.8 to 100.8 Gy, the value giving a 5% NTCP for the rectum was found (D(NTCP(rectum)=5%)) using two different methods, and the corresponding TCP(NTCP(rectum)=5%) and NTCP(NTCP(rectum)=5%) for the other critical structures were derived. With the first method, the inverse optimization of the plans was performed just at a fixed 75.6 Gy ICRU dose; with the second method (applied to 2/5 patients) inverse treatment plannings were re-optimized at many dose levels (from 64.8 to 108 Gy with 3.6 Gy intervals). In this case, three different values of alpha/beta (10, 3, 1.5)were used for TCP calculation. The 3DCRT plan consisted of a 3-fields technique; in the IMRT plans, five equi-spaced beams were applied. The Helios Inverse Planning software from Varian was used for both the 2D IMRT and the 1D IMRT inverse optimization, the last one being performed fixing only one available pair of leaves for modulation. A previously proposed forward 1D IMRT 'class solution' technique was also considered, keeping the same irradiation geometry of the inversely optimized IMRT techniques. RESULTS With the first method, the average gains in TCP(NTCP(rectum)=5%) of the 2D IMRT technique, with respect 3DCRT, were 10.3 and 7.8%, depending on the choice of the DVHs constraints during the inverse optimization procedure (set (a) and set (b), respectively). The average gain (DeltaTCP(NTCP(rectum)=5%)) coming from the inverse 1D IMRT optimization was 5.0%, when fixing the set (b) DVHs constraints. Concerning the forward 1D IMRT optimization, the average gain in TCP(NTCP(rectum)=5%) was 4.5%. The gain was found to be correlated with the degree of overlapping between rectum and PTV. When comparing 2D IMRT and 1D IMRT, in the case of the more realistic set (b) constraints, DeltaTCP(NTCP(rectum)=5%) was always less than 3%, excepting one patient with a very large overlap region. Basing our choice on this result, the second method was applied to this patient and one of the remaining. Through the inverse re-optimization of the treatment plans at each dose level, the gain in TCP(NTCP(rectum)=5%) of the inverse 2D technique was significantly higher than the ones obtained by applying the first method (concerning the two patients: +6.1% and +2.4%), while no significant benefit was found for inverse 1D. The impact of changing the alpha/beta ratio was less evident in the patient with the lower gain in TCP(NTCP(rectum)=5%). CONCLUSIONS The expected benefit due to IMRT with respect to 3DCRT seems to be relevant when the overlap between PTV and rectum is high. Moreover, the difference between the inverse 2D and the simpler inverse or forward 1D IMRT techniques resulted in being relatively modest, with the exception of one patient, having a very large overlap between rectum and PTV. Optimizing the inverse planning at each dose level to find TCP(NTCP(rectum)=5%)e level to find TCP(NTCP(rectum)=5%) can improve the performances of inverse 2D IMRT, against a significant increase of the time for planning. These results suggest the importance of selecting the patients that could have significant benefit from the application of IMRT.
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Affiliation(s)
- Daniela Corletto
- Servizio di Fisica Sanitaria, H San Raffaele, Via Olgettina 60, 20132 Milan, Italy
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