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Sasaki M, Nakaguchi Y, Kamomae T, Tsuzuki A, Sawada S, Shibuya K, Oita M, Tominaga M, Tominaga Y, Ikushima H. Comparative analysis of two dose-volume histogram prediction tools for treatment planning in volumetric-modulated arc therapy: A multi-planner study. Med Dosim 2024:S0958-3947(24)00012-8. [PMID: 38556402 DOI: 10.1016/j.meddos.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/21/2024] [Accepted: 02/24/2024] [Indexed: 04/02/2024]
Abstract
The increase in high-precision radiation therapy, particularly volumetric-modulated arc therapy (VMAT), has increased patient numbers and expanded treatment sites. However, a significant challenge in VMAT treatment planning is the inconsistent plan quality among different planners and facilities. This study explored the use of dose-volume histogram (DVH) prediction tools to address these disparities, specifically focusing on RapidPlan (Varian Medical Systems) and PlanIQ (Sun Nuclear). RapidPlan predicts achievable DVHs and automatically generates optimization objectives. While it has demonstrated organ-at-risk (OAR) dose reduction benefits, the quality of the plan used to build its model significantly affects its predictions. On the other hand, PlanIQ offers ease of use and does not require prior model-building. Five planners participated in this study, each creating two treatment plans: one referencing RapidPlan and the other using PlanIQ. The planners had the freedom to adjust parameters while referencing the DVH predictions. The plans were evaluated using "Plan Quality Metric" (PQM) scores to assess the planning target volume excluding the rectum and OARs. The results revealed that RapidPlan-referenced plans often outperformed PlanIQ-based plans, with less interplanner variability. PlanIQ played a pivotal role in the construction of the RapidPlan model. This study is the first to compare plans generated by multiple planners using both tools. This study provides insights into optimizing treatment planning by considering the characteristics of both RapidPlan and PlanIQ.
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Affiliation(s)
- Motoharu Sasaki
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan.
| | | | - Takeshi Kamomae
- Radioisotope Research Center, Nagoya University, Nagoya, Aichi 466-8550, Japan; Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
| | - Akira Tsuzuki
- Department of Radiological Technology, Kakogawa Central City Hospital, Kakogawa, Hyogo 675-8611, Japan
| | - Soma Sawada
- School of Health Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
| | - Koki Shibuya
- School of Health Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
| | - Masataka Oita
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University
| | - Masahide Tominaga
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
| | - Yuki Tominaga
- Department of Radiotherapy, Medical Co. Hakuhokai, Osaka Proton Therapy Clinic, Osaka, Osaka 554-0022, Japan
| | - Hitoshi Ikushima
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
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Jóhannesson V, Gunnlaugsson A, Nilsson P, Brynolfsson P, Kjellén E, Wieslander E. Dose-volume relationships of planned versus estimated delivered radiation doses to pelvic organs at risk and side effects in patients treated with salvage radiotherapy for recurrent prostate cancer. Tech Innov Patient Support Radiat Oncol 2024; 29:100231. [PMID: 38192583 PMCID: PMC10772375 DOI: 10.1016/j.tipsro.2023.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/26/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose To investigate estimated delivered dose distributions using weekly cone-beam computed tomography (CBCT) scans for pelvic organs at risk (OARs) in salvage radiotherapy (SRT) after radical prostatectomy. Furthermore, to compare them with the originally planned dose distributions and analyse associations with gastrointestinal (GI) and genitourinary (GU) side effects. Methods This study is part of a phase II trial involving SRT for recurrent prostate cancer. Treatment was personalised based on PSA response during SRT, classifying patients as PSA responders or non-responders. Estimated radiation dose distributions were obtained using deformable image registration from weekly CBCT scans. GI and GU toxicities were assessed using the RTOG toxicity scale, while patient-reported symptoms were monitored through self-assessment questionnaires. Results The study included 100 patients, with similar treatment-related side effects observed in both responders and non-responders. Differences in dose-volume metrics between the planned and estimated delivered doses for the examined OARs were mostly modest, although generally statistically significant. We identified statistically significant associations between QUANTEC-recommended dose-volume constraints and acute bowel toxicity, as well as late urinary patient-reported symptoms, for both the estimated delivered and planned dose distributions. Conclusion We found small but statistically significant differences between estimated delivered and planned doses to OARs. These differences showed trends toward improved associations for estimated delivered dose distributions with side effects. Enhanced registration methods and imaging techniques could potentially further enhance the assessment of truly delivered doses and yield more reliable dose-volume constraints for future therapies.
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Affiliation(s)
- Vilberg Jóhannesson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden
| | - Adalsteinn Gunnlaugsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden
| | - Per Nilsson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Radiation Physics, Lund, Sweden
| | - Patrik Brynolfsson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Elisabeth Kjellén
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden
| | - Elinore Wieslander
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
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Bao X, Wang Y, Li B, Peng L, Ouyang B, Ng CL, Zhuo Y, Wang Q, Li C, Li J. Clinical and dosimetric predictors of radiation-induced rhinosinusitis following VMAT for nasopharyngeal carcinoma: A retrospective study. Heliyon 2024; 10:e23554. [PMID: 38187301 PMCID: PMC10770446 DOI: 10.1016/j.heliyon.2023.e23554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background We aimed to investigate the clinical and dosimetric factors associated with radiation-induced rhinosinusitis, and further elucidate the optimal dose-volume constraints for nasopharyngeal cancer patients who underwent volumetric-modulated arc therapy (VMAT). Methods A retrospective review of 196 nasopharyngeal carcinoma (NPC) patients who underwent definitive VMAT between August 2018 and May 2021 was conducted. Both clinical and dose-volume histogram (DVH) data of NPC patients without rhinosinusitis at baseline were selected for analysis. Results The cumulative incidence of post-RT rhinosinusitis at the 3-, 6-, 9-, and 12-months, and >1 year were 29.6 %, 41.3 %, 42.9 %, and 45.4 %, and 47.4 %, respectively. Nasal irrigation was negatively associated with post-RT rhinosinusitis (p < 0.001). Higher cumulative incidences of maxillary and ethmoid sinusitis were associated with V70 > 1.16 % and >1.00 %, respectively (p = 0.027 and p = 0.002). Sphenoid sinusitis was more frequent when Dmax(maxillary sinus) exceeded 69.2Gy (p = 0.005). Conclusions Regular nasal irrigation may reduce the development of rhinosinusitis. Dose-volume constraints of V70 and Dmax to the maxillary sinus are suggested for VMAT planning. Patients exceeding these thresholds should be closely monitored and potentially offered preventative interventions within 3-6 months post-RT.
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Affiliation(s)
- Xiaomin Bao
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Yan Wang
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong, Guangzhou, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong, Guangzhou, China
| | - Liang Peng
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Bin Ouyang
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat‐sen University, Guangdong, Guangzhou, China
| | - Chew Lip Ng
- Department of Otolaryngology-Head and Neck Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Yongshi Zhuo
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Qiumin Wang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Chunwei Li
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
| | - Jian Li
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, Guangzhou, China
- Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, Guangxi, Nanning, China
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Mishra H, Singh S, Mishra R, Pandey A, Mandal A, Prakash E, Patel G, Shah M, Singh TB. Evaluation of survival outcome and prognostic factors for oral cavity cancer treated with volumetric arc therapy. J Cancer Res Clin Oncol 2023; 149:16983-16992. [PMID: 37740764 DOI: 10.1007/s00432-023-05397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/02/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE This study aimed to evaluate the survival outcomes and identify prognostic factors for patients with oral cavity cancer (OCC) who underwent adjuvant treatment with volumetric arc therapy (VMAT) using simultaneous integrated boost (SIB). METHODS Data was collected for post-operated patients of carcinoma of oral cavity who received adjuvant VMAT with SIB between June 2018 and December 2022. The data was entered and analyzed using SPSS software version 20.0. Survival rates were estimated using Kaplan Meier method. To determine survival difference between the groups, log rank test was used. Multivariate analyses were performed with Cox proportional hazard model and p value < 0.05 was considered as significant. RESULTS A total of 178 patients were included in the study. The median follow-up period was 26 months (range 3-56 months). The 3-year OS, DFS, and LRC rates were 78% (95% CI 77-79%), 76% (95% CI 74-77%), and 81% (95% CI 80-82%), respectively. Univariate analysis identified age ≥ 50 years, lymph node involvement, extracapsular extension (ECE), and N2-N3 disease as significant adverse prognostic factors for OS, DFS, and LRC. Multivariate analysis confirmed age ≥ 50 years and nodal involvement as independent predictors of worse OS, DFS, and LRC. Additionally, ECE independently affected OS and DFS. CONCLUSION Adjuvant treatment with VMAT using SIBin patients with OCC is effective. Age and nodal involvement had significant impact on LRC, DFSand OS while ECE on DFSand OS.
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Affiliation(s)
- Himanshu Mishra
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Shreya Singh
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Ritusha Mishra
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India.
| | - Ankita Pandey
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Abhijit Mandal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Ekta Prakash
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Ganeshkumar Patel
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Manav Shah
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Tej Bali Singh
- N.M.H.P., Centre of Excellence, Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
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Anjidani S, Siavashpour Z, Houshyari M, Haghgoo M, Nazarnejad M, Zayeri F, Alireza Javadinia S. A dosimetric comparative study following RTOG and ESTRO contouring guidelines for breast radiation therapy. Cancer Radiother 2023; 27:413-420. [PMID: 37482461 DOI: 10.1016/j.canrad.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE To compare the dosimetric parameters considering the Radiation Therapy Oncology Group (RTOG) and European Society for Radiotherapy and Oncology (ESTRO) guidelines for breast cancer radiotherapy. Two radiotherapy techniques, intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT), were considered. PATIENTS AND METHODS Twenty-eight patients with left-sided medially-located TanyN2M0 tumors were contoured based on RTOG and ESTRO guidelines. 9-field IMRT, 10-field IMRT, 11-field IMRT, and VMAT treatment plans were applied as radiotherapy (RT) techniques for both contouring sets. The dosimetric parameters of the RT plans were extracted and compared. RESULTS Comparing dose-volume histogram (DVH) parameters, equivalent uniform dose (EUD), and normal tissue complication probability (NTCP) of OARs across the contouring guidelines and considering each RT technique showed that the only significant differences were higher Dmax, Dmean, V30, and V45, EUD, and NTCP of the thyroid in all treatment modalities when the RTOG guideline had been adopted. Using the VMAT technique, PTV's EUD and the tumor control probability (TCP) were considerably higher when the ESTRO guideline was adopted. Moreover, the conformity index (CI) of VMAT plans was significantly higher when the ESTRO guideline was used. CONCLUSION Unless having higher doses to thyroid when the RTOG guideline was adopted, the doses to other organs-at-risk (OAR) were similar between the two considering guidelines. Moreover, except for higher EUD, TCP, and CI for VMAT when the ESTRO guideline was used, no other significant differences were obtained between dosimetric parameters of target volumes considering the RT techniques and contouring guidelines.
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Affiliation(s)
- Sh Anjidani
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z Siavashpour
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - M Houshyari
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Haghgoo
- Department of Control Engineering, School of Electrical and Computer Engineering, Tarbiat Modares University (TMU), Tehran, Iran
| | - M Nazarnejad
- Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - F Zayeri
- Proteomics Research Center and Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Qods Square, Darband Street, Tehran, Iran
| | - S Alireza Javadinia
- Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Wada Y, Monzen H, Ishida N, Ri A, Tatsuno S, Uehara T, Inada M, Doi H, Nakamatsu K, Hosono M, Nishimura Y. Impact of rectal gas on the planning target volume margin for pelvic bone and prostate matching in prostate cancer patients receiving volumetric-modulated arc therapy. Med Dosim 2023:S0958-3947(23)00030-4. [PMID: 37080819 DOI: 10.1016/j.meddos.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
We performed daily cone-beam computed tomography (CBCT) to determine the impact of rectal gas on the movements of prostate and seminal vesicles (SVs). We aimed to determine the relationship between planning target volume (PTV) margins and rectal gas. In 30 treatments of 15 prostate cancer patients, excessive rectal gas was removed and CBCT images were analyzed. Image registration between planning CT and daily CBCT images before and after rectal gas removal was performed for pelvic bone and prostate matching. The couch movement distance between each matching was considered the prostate movement. In addition, we measured SV tip movement between each matching. The anterior-posterior movement of the prostate before rectal gas removal (3.1 ± 2.9 mm) was significantly greater than that after rectal gas removal (1.2 ± 1.2 mm; p < 0.01). The left-right and superior-inferior movements were similar regardless of the presence or absence of rectal gas. The SV movement distances before and after rectal gas removal were 11.0 ± 5.8 mm and 4.6 ± 3.8 mm, respectively (p < 0.01), in pelvic bone matching, and 8.0 ± 4.2 mm and 3.8 ± 3.2 mm, respectively (p < 0.01), in prostate matching. After rectal gas removal, the SV position did not differ significantly between each matching. In 26 of the 30 treatments, SV movement distance in the presence of rectal gas was >6 mm, which is the minimum PTV margin at our institution. In comparison, after rectal gas removal and prostate matching, only 6 treatments demonstrated an SV movement distance of >6 mm. In the presence of rectal gas, the SVs require greater PTV margins than the prostate. Rectal gas removal should be considered if the movement distance on prostate matching is greater than the minimum PTV margin at treating institution.
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Affiliation(s)
- Yutaro Wada
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan.
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Naoko Ishida
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Aritoshi Ri
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Saori Tatsuno
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Takuya Uehara
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Masahiro Inada
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Makoto Hosono
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, 589-8511, Japan
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Miyata J, Tominaga Y, Kondo K, Sonoda Y, Hanazawa H, Sakai M, Itasaka S, Oita M, Kuroda M. Dosimetric comparison of pencil beam scanning proton therapy with or without multi-leaf collimator versus volumetric-modulated arc therapy for treatment of malignant glioma. Med Dosim 2023; 48:105-112. [PMID: 36914455 DOI: 10.1016/j.meddos.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 03/14/2023]
Abstract
This study aimed to examine the dosimetric effect of intensity-modulated proton therapy (IMPT) with a multi-leaf collimator (MLC) in treating malignant glioma. We compared the dose distribution of IMPT with or without MLC (IMPTMLC+ or IMPTMLC-, respectively) using pencil beam scanning and volumetric-modulated arc therapy (VMAT) in simultaneous integrated boost (SIB) plans for 16 patients with malignant gliomas. High- and low-risk target volumes were assessed using D2%, V90%, V95%, homogeneity index (HI), and conformity index (CI). Organs at risk (OARs) were evaluated using the average dose (Dmean) and D2%. Furthermore, the dose to the normal brain was evaluated using from V5Gy to V40Gy at 5 Gy intervals. There were no significant differences among all techniques regarding V90%, V95%, and CI for the targets. HI and D2% for IMPTMLC+ and IMPTMLC- were significantly superior to those for VMAT (p < 0.01). The Dmean and D2% of all OARs for IMPTMLC+ were equivalent or superior to those of other techniques. Regarding the normal brain, there was no significant difference in V40Gy among all techniques whereas V5Gy to V35Gy in IMPTMLC+ were significantly smaller than those in IMPTMLC- (with differences ranging from 0.45% to 4.80%, p < 0.05) and VMAT (with differences ranging from 6.85% to 57.94%, p < 0.01). IMPTMLC+ could reduce the dose to OARs, while maintaining target coverage compared to IMPTMLC- and VMAT in treating malignant glioma.
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Affiliation(s)
- Junya Miyata
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Okayama, Japan; Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yuki Tominaga
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Okayama, Japan; Department of Radiotherapy, Medical Co. Hakuhokai, Osaka Proton Therapy Clinic, Osaka, Osaka, Japan
| | - Kazuto Kondo
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yasuaki Sonoda
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hideki Hanazawa
- Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Mami Sakai
- Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Satoshi Itasaka
- Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masataka Oita
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Okayama, Japan.
| | - Masahiro Kuroda
- Graduate School of Health Sciences, Okayama University, Okayama, Okayama, Japan
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Kubo K, Kenjo M, Tominaga A, Magaki T, Kawabata H, Miura H, Nagata Y. Volumetric-Modulated Arc Therapy for Giant-Cell Tumor of Temporal Bone: An Illustrative Case Report. Case Rep Oncol 2022; 15:861-867. [PMID: 36825097 PMCID: PMC9941786 DOI: 10.1159/000526160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
Giant-cell tumor of the skull is extremely rare. Surgery is the main treatment for this disease, but not all cases are suitable for complete resection. In this report, we present the clinical features of a case of giant-cell tumor of temporal bone that demonstrated good outcome after radiation therapy (RT) using volumetric-modulated arc therapy (VMAT). The patient was a 55-year-old man with giant-cell tumor of temporal bone who received surgery as the first treatment. Three months after the initial surgery, the tumor regrew, and the patient received surgical resection again. Although second partial resection was undergone, it regrew. Therefore, 36 months after initial surgery, RT was conducted. The prescribed dose was 54 Gy in 1.8 Gy fractions using VMAT. The tumor began to shrink from 4 months after the initiation of RT and kept shrinking slowly and gradually. At the last follow-up, there was no evidence of local recurrence. There was no report about VMAT for giant-cell tumor of the skull, and no report revealed the radiographic details after recent radiation techniques. Therefore, this case report was meaningful in describing the details and response during and after VMAT for giant-cell tumor of temporal bone. The adjuvant RT using VMAT seemed to demonstrate a sufficient local control benefit without severe adverse effects in our case with giant-cell tumor of temporal bone.
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Affiliation(s)
- Katsumaro Kubo
- aDepartment of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Kobe-shi, Japan,*Katsumaro Kubo,
| | - Masahiro Kenjo
- bHiroshima High-Precision Radiotherapy Cancer Center, Hiroshima-shi, Japan
| | - Atsushi Tominaga
- cDepartment of Neurosurgery, Hiroshima Prefectural Hospital, Hiroshima-shi, Japan
| | - Takuro Magaki
- cDepartment of Neurosurgery, Hiroshima Prefectural Hospital, Hiroshima-shi, Japan
| | - Hideo Kawabata
- dDepartment of Radiation Oncology, Hiroshima Prefectural Hospital, Hiroshima-shi, Japan
| | - Hideharu Miura
- bHiroshima High-Precision Radiotherapy Cancer Center, Hiroshima-shi, Japan
| | - Yasushi Nagata
- bHiroshima High-Precision Radiotherapy Cancer Center, Hiroshima-shi, Japan,eDepartment of Radiation Oncology, Hiroshima University Hospital, Hiroshima-shi, Japan
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He DC, Zhu ZJ, Zhang XY, Zhang Y, Hong J, Shi TT, Han JH. Evaluating the influence of 6MV and 10MV photon beams on cervical volumetric-modulated arc therapy plans. Technol Health Care 2022; 30:1515-1523. [PMID: 35661033 DOI: 10.3233/thc-213617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cervical cancer is a common gynecological cancer among women worldwide. OBJECTIVE To determine the effects of 6 MV and 10 MV volumetric-modulated arc therapy (VMAT) photon beams on the target volume (TV) planning and critical organs in cases of cervical cancer. METHODS Fifty patients with carcinoma of the cervix who underwent radiotherapy were selected. The transverse diameter (T) of the cross section of the upper edge of the sacroiliac joint on computerized tomography images of the patients was measured, and the mean value was calculated as 34 cm. All patients were divided into two groups: Group A (T < 34 cm) and Group B (T > 34 cm). The VMAT plans were generated using 6 MV and 10 MV plans separately. The prescription dose was 47.5 Gy, and the daily dose was 1.9 Gy. RESULTS In Group A, the planned TV (PTV) dose assessment parameters of 6 MV and 10 MV plans and their homogeneity and conformity indices were not statistically significantly different. A significant difference was observed between the 6 MV and 10 MV plans for the PTV dose assessment parameters and the homogeneity index of the plans for Group B. The monitor units of the 10 MV plans were lower than in the 6 MV plans in both Groups A and B, and the difference was statistically significant. The assessment parameter V40 Gy of both the rectum and bladder in the 6 MV plans was smaller than the corresponding parameter in the 10 MV plans in Group A; in Group B, the assessment parameter V50 Gy of the rectum in the 10 MV plans was smaller than in the 6 MV plans. CONCLUSION When T < 34 cm, 6 MV energy is more suitable for the external irradiation of cervical cancer. When T > 34 cm, 10 MV energy is more suitable for cervical cancer radiotherapy. Therefore, 10 MV should be considered for patients with a large abdominal size.
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Ahrouch I, Van Gestel D, Koshariuk O, Kirkove C, Desmet A, Philippson C, Reynaert N, De Caluwe A. Unintended dose to the lower axilla in adjuvant radiotherapy for breast cancer: Differences between tangential beam and VMAT. Radiother Oncol 2021; 164:282-288. [PMID: 34648872 DOI: 10.1016/j.radonc.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate dosimetric differences in unintended dose to the lower axilla between 3D-standard (3DCRT), tangential beam forward intensity modulated radiotherapy (F-IMRT) and volumetric modulated arc therapy (VMAT). The objective is to evaluate whether results of clinical trials, such as the ACOSOG-Z011 trial, that evaluated omission of axillary clearance can be extrapolated towards more conformal techniques like VMAT. MATERIALS AND METHODS Twenty-five consecutive patients treated with whole breast radiotherapy alone (WBRT) using a F-IMRT technique were identified. Three additional plans were created for every patient: one plan using a single 270° arc (VMAT 1x270°), another using two small ≤90° opposing arcs (VMAT 2x < 90°) and thirdly a 3DCRT plan without F-IMRT. Axillary levels I-II were contoured after the treatment plans were made. RESULTS The volume of the axilla level I that was covered by the 50% isodose (V50%) was significantly higher for VMAT 2x < 90° (71.3 cm3, 84% of structure volume, p < 0.001) and VMAT 1x270° (68.8 cm3, 81%, p < 0.01) compared to 3DCRT (60.3 cm3, 71%) and F-IMRT (60.8 cm3, 72%). The V50% to the axilla level II, however, was low for all techniques: 12.3 cm3 (12%); 8.9 cm3 (9%); 4.3 cm3 (4%); 4.4 cm3 (4%) for VMAT 2x < 90°, VMAT 1x270°, 3DCRT, F-IMRT, respectively. For the higher doses (V90% and above), no clinically relevant differences were seen between the different modalities. CONCLUSION WBRT treatments with VMAT do not lead to a significant reduction of the unintended axillary dose in comparison with a tangential beam setup. Hence, concerning tumor control, VMAT can be applied to clinical situations similar to the Z0011 trial. The intermediate axillary dose is higher with VMAT, but the clinical consequence of this difference on toxicity is unknown.
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Affiliation(s)
- Imane Ahrouch
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Olga Koshariuk
- Department of Radiation Oncology, Clinique St Elisabeth, Namur, Belgium
| | - Carine Kirkove
- Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Antoine Desmet
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Catherine Philippson
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Nick Reynaert
- Department of Medical Physics, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Alex De Caluwe
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium.
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Wei Z, Peng X, Wang Y, Yang L, He L, Liu Z, Wang J, Mu X, Li R, Xiao J. Influence of target dose heterogeneity on dose sparing of normal tissue in peripheral lung tumor stereotactic body radiation therapy. Radiat Oncol 2021; 16:167. [PMID: 34461954 PMCID: PMC8404286 DOI: 10.1186/s13014-021-01891-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate the influence of target dose heterogeneity on normal tissue dose sparing for peripheral lung tumor stereotactic body radiation therapy (SBRT). METHODS Based on the volumetric-modulated arc therapy (VMAT) technique, three SBRT plans with homogeneous, moderate heterogeneous, and heterogeneous (HO, MHE, and HE) target doses were compared in 30 peripheral lung tumor patients. The prescription dose was 48 Gy in 4 fractions. Ten rings outside the PTV were created to limit normal tissue dosage and evaluate dose falloff. RESULTS When MHE and HE plans were compared to HO plans, the conformity index of the PTV was increased by approximately 0.08. The median mean lung dose (MLD), V5, V10, V20 of whole lung, D2%, D1cc, D2cc of the rib, V30 of the rib, D2% and the maximum dose (Dmax) of the skin, and D2% and Dmax of most mediastinal organs at risk (OARs) and spinal cord were reduced by up to 4.51 Gy or 2.8%. Analogously, the median Dmax, D2% and mean dose of rings were reduced by 0.71 to 8.46 Gy; and the median R50% and D2cm were reduced by 2.1 to 2.3 and 7.4% to 8.0%, respectively. Between MHE and HE plans there was little to no difference in OARs dose and dose falloff beyond the target. Furthermore, the dose sparing of rib V30 and the mean dose of rings were negatively correlated with the rib and rings distance from tumor, respectively. CONCLUSIONS For peripheral lung tumor SBRT, target conformity, normal tissue dose, and dose falloff around the target could be improved by loosening or abandoning homogeneity. While there was negligible further dose benefit for the maximum target dose above 125% of the prescription, dose sparing of normal tissue derived from a heterogeneous target decreased as the distance from the tumor increased.
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Affiliation(s)
- Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Wang
- School of Computer Science, Sichuan University, Chengdu, 610000, China
| | - Lianlian Yang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheran Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoli Mu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruidan Li
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
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Inoue E, Doi H, Monzen H, Tamura M, Inada M, Ishikawa K, Nakamatsu K, Nishimura Y. Dose-volume Histogram Analysis of Knowledge-based Volumetric-modulated Arc Therapy Planning in Postoperative Breast Cancer Irradiation. In Vivo 2021; 34:1095-1101. [PMID: 32354897 DOI: 10.21873/invivo.11880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM We evaluated the dosimetric profiles of manually generated volumetric-modulated arc therapy (VMAT) plans and performance of a commercial knowledge-based planning system (KBP) in treating breast cancer. MATERIALS AND METHODS We defined the manually generated VMAT plan as the manual plan (MP). Twenty MPs were generated for left-sided breast cancer patients who underwent breast-conserving surgery and used to develop a KBP training set. The other five patients were used for validation. The dosimetric parameters among MPs, tangential irradiation plans (TPs), and KBP-VMAT plans (KBP-Ps) were compared. RESULTS D95 and homogeneity of the planning target volume (PTV) were significantly higher and greater in MPs and KBP-Ps than in TPs. Lung V20, V40 The Dmean for the left anterior descending artery was lower in MPs and KBP-Ps than in TPs. KBP could save time in generating VMAT plans. CONCLUSION MPs and KBP-Ps could ensure higher dose uniformity of PTV than TPs. KBP could faster generate comparable MPs for breast cancer.
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Affiliation(s)
- Eri Inoue
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Masahiro Inada
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuki Ishikawa
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
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Kim J, Han MC, Park K, Chang KH, Kim DW, Hong CS, Kim JS. Commissioning and clinical implementation of Mobius3D and MobiusFX: Experience on multiple linear accelerators. Phys Med 2020; 80:1-9. [PMID: 33070006 DOI: 10.1016/j.ejmp.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To provide practical guidelines for Mobius3D commissioning based on experiences of commissioning/clinical implementation of Mobius3D and MobiusFX as patient-specific quality assurance tools on multiple linear accelerators. METHODS The vendor-suggested Mobius3D commissioning procedures, including beam model adjustment and dosimetric leaf gap (DLG) optimization, were performed for 6 MV X-ray beams of six Elekta linear accelerators. For the beam model adjustment, beam data, such as the percentage depth dose, off-axis ratio (OAR), and output factor (OF), were measured using a water phantom and compared to the vendor-provided reference values. DLG optimization was performed to determine an optimal DLG correction factor to minimize the mean difference between Mobius3D-calculated and measured doses for multiple volumetric modulated arc therapy (VMAT) plans. Small-field VMAT plans, in which Mobius3D has dose calculate uncertainties, were initially included in the DLG optimization, but excluded later. RESULTS The measured beam data were consistent across the six linear accelerators. Relatively large differences between the reference and measured values were observed for the OAR at large off-axis distances (>5 cm) and for the OF for small fields (<3 × 3 cm2). The optimal DLG correction factor was 0.6 ± 0.3 (range: 0.3-1.0) with small-field plans and 0.2 ± 0.2 (0.0-0.5) without them. CONCLUSIONS A reasonable agreement was found between the vendor-provided reference and measured beam models. DLG optimization results were dependent on the selection of the VMAT plans, requiring careful attention to the known dose calculation uncertainties of Mobius3D when determining a DLG correction factor.
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Affiliation(s)
- Jihun Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwangwoo Park
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Hwan Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Wook Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea.
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Monzen H, Tamura M, Ueda Y, Fukunaga JI, Kamima T, Muraki Y, Kubo K, Nakamatsu K. Dosimetric evaluation with knowledge-based planning created at different periods in volumetric-modulated arc therapy for prostate cancer: a multi-institution study. Radiol Phys Technol 2020; 13:327-335. [PMID: 32986184 DOI: 10.1007/s12194-020-00585-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/22/2022]
Abstract
Dosimetric evaluation and variation assessment were performed with two knowledge-based planning (KBP) models created at different periods for volumetric-modulated arc therapy (VMAT) for prostate cancer at five institutes. The first and second models (F- and S-models) for KBP were created before April 2017 and April 2019, respectively. The S-model was created using feedback plans from the F-model. Dose evaluation was compared between the two models using the same two computed tomography (CT) datasets and structures. The evaluation metrics were the dose received by 95.0% and 2.0% of the planning target volume (PTV); dose-volume parameters to the rectum and bladder as V90, V80, and V50; and monitor unit (MU). Dosimetric variation was compared by exporting estimated dose-volume histograms for each model to the Model Analytics website and assessing the organ at risk volume. There were no dosimetric differences between the two models for PTV. The V50 of the rectum in the S-model had improved compared to that of the F-model (case I: 49.3 ± 15.6 and 43.5 ± 15.2 [p = 0.08]; case II: 42.5 ± 16.9 and 36.0 ± 15.6 [p = 0.138]). The differences in other parameters were within ± 1.8% between the rectum and the bladder. The MU was slightly higher in the S-model than in the F-model, and dosimetric variation was reduced to the rectum and bladder among all the institutes. The polished S-model for KBP could be used for standardization of the plan quality and sharing of KBP models in VMAT for prostate cancer.
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Affiliation(s)
- Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Jun-Ichi Fukunaga
- Divisin of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuya Kamima
- Department of Radiation Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yuta Muraki
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Kazuki Kubo
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
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Wee CW, Kim KS, Kim CY, Han JH, Kim YJ, Kim IA. Feasibility of hippocampus-sparing VMAT for newly diagnosed glioblastoma treated by chemoradiation: pattern of failure analysis. Radiat Oncol 2020; 15:98. [PMID: 32375876 PMCID: PMC7204282 DOI: 10.1186/s13014-020-01552-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
Background To identify the pattern of failure and oncological safety of hippocampus (HC)-sparing IMRT (HSRT) in newly diagnosed glioblastoma (GBM) patients. Materials and methods Eighty-two GBM patients treated with temozolomide-based chemoradiation using HSRT between 2014 and 2018 were retrospectively reviewed. HSRT consisted of a sparing of Dmax of the contralateral HC < 17 Gy. Fifteen patients were unable to achieve the dose-constraints for adequate target coverage. The dose to ipsilateral HC was kept as low as possible. The pattern of failure was investigated, focusing on the area in the vicinity of the spared HC (organ and + 1 cm area). The median HSRT dose was 60 Gy in 30 fractions. Results The median follow-up for survivors was 11.7 months. The median progression-free and overall survival were 9.7 and 23.5 months, respectively. Six (7.3%) and eight (9.8%) patients eventually demonstrated progressive disease at the contralateral HC and HC + 1 cm, respectively. The 12-month contralateral HC and HC + 1 cm failure-free rate were 97.2 and 93.4%, respectively. However, no patient (0%) and two patients (2.4%) showed failure at contralateral HC and HC + 1 cm at initial progression, respectively. The dominant pattern of failure at the contralateral HC was by subependymal seeding (66.7%). Conclusion The incidence of failure at the contralateral HC and HC + 1 cm is very low and mostly accompanied by disseminated disease progression after HSRT. Since HSRT does not compromise oncological outcomes, it could be considered especially for GBM patients who are expected to have favorable survival outcomes.
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Affiliation(s)
- Chan Woo Wee
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Kyung Su Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea. .,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Takizawa T, Tanabe S, Utsunomiya S, Nakano H, Yamada T, Sakai H, Ohta A, Saito H, Nakano T, Abe E, Kaidu M, Aoyama H. Dosimetric comparison of analytic anisotropic algorithm and Acuros XB algorithm in VMAT plans for high-grade glioma. Phys Med 2020; 73:73-82. [PMID: 32330814 DOI: 10.1016/j.ejmp.2020.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To investigate the dosimetric impact between the anisotropic analytical algorithm (AAA) and the Acuros XB (AXB) algorithm in volumetric-modulated arc therapy (VMAT) plans for high-grade glioma (HGG). METHODS We used a heterogeneous phantom to quantify the agreement between the measured and calculated doses from the AAA and from the AXB. We then analyzed 14 patients with HGG treated by VMAT, using the AAA. We newly created AXB plans for each corresponding AAA plan under the following conditions: (1) re-calculation for the same number of monitor units with an identical beam and leaf setup, and (2) re-optimization under the same conditions of dose constraints. The dose coverage for the planning target volume (PTV) was evaluated by dividing the coverage into the skull, air, and soft-tissue regions. RESULTS Compared to the results obtained with the AAA, the AXB results were in good agreement with the measured profiles. The dose differences in the PTV between the AAA and re-calculated AXB plans were large in the skull region contained in the target. The dose difference in the PTV in both types of plan was significantly correlated with the volume of the skull contained in the target (r = 0.71, p = 0.0042). A re-optimized AXB plan's dose difference was lower vs. the re-calculated AXB plan's. CONCLUSIONS We observed dose differences between the AAA and AXB plans, in particular in the cases in which the skull region of the target was large. Considering the phantom measurement results, the AXB algorithm should be used in VMAT plans for HGG.
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Huang TL, Tsai MH, Chuang HC, Chien CY, Lin YT, Tsai WL, Fang FM. Quality of life and survival outcome for patients with nasopharyngeal carcinoma treated by volumetric-modulated arc therapy versus intensity-modulated radiotherapy. Radiat Oncol 2020; 15:84. [PMID: 32307024 PMCID: PMC7168825 DOI: 10.1186/s13014-020-01532-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To evaluate the longitudinal changes of quality of life (QoL) and survival in patients with nasopharyngeal carcinoma (NPC) treated by volumetric-modulated arc therapy (VMAT) versus intensity-modulated radiotherapy (IMRT). METHODS One hundred and forty non-distant metastatic NPC patients treated by VMAT (n = 66) or IMRT (n = 74) with simultaneously integrated boost between March 2013 and December 2015 at a single institute were analyzed. QoL was prospectively assessed by the EORTC QLQ-C30 and HN35 questionnaires at the four time points: before RT, RT 42.4 Gy (20 fractions), and 3, 12 months after RT. RESULTS The 3-year locoregional relapse-free survival, distant metastasis-free survival, failure-free survival, and overall survival rates were 96.6, 89.4, 86.1%, and 87.4 for the VMAT group, respectively, compared with 91.4, 90.0, 79.8, and 91.3% for the IMRT group (p value > 0.05). The pattern of QoL changes was similar between the VMAT and IMRT group. No statistically or clinically significant difference in all the QoL scales was observed between VMAT and IMRT group at each time point. Compared to before RT, we observed statistically (p<0.05) and clinically (difference of mean scores≧10) better outcome in global QoL and social functioning, but worse head and neck symptomatic outcome in swallowing, taste/smell, opening mouth, dry mouth, and sticky saliva at the time point of 1 year after RT for both groups. CONCLUSION The study provides the evidence that the tumor control, survival and changes of QoL is compatible for NPC patients treated by VMAT versus IMRT.
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Affiliation(s)
- Tai-Lin Huang
- Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Hsien Tsai
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Ching Chuang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Tsai Lin
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Ling Tsai
- Department of Cosmetics and Fashion Styling, Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung, 83347, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123 Ta-Pei Rd., Niao Sung District, Kaohsiung, Taiwan.
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Onal C, Bozca R, Dolek Y, Guler OC, Arslan G. Incidental testicular doses during volumetric-modulated arc radiotherapy in prostate cancer patients. Radiol Med 2020; 125:777-783. [PMID: 32125635 DOI: 10.1007/s11547-020-01158-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the incidental testicular doses during volumetric-modulated arc therapy (VMAT) in patients receiving prostate-only and pelvic lymphatic irradiation. MATERIALS AND METHODS Testicular doses in 40 intermediate- and high-risk prostate cancer patients were determined on treatment planning system (TPS) using the VMAT technique at 6 MV. Scattered testicular doses were also measured by MOSFET detectors placed on testis surface. The testicular doses of patients treated with prostate-only and pelvic field irradiation were compared. RESULTS The median testicular doses measured per 200 cGy fraction by TPS and MOSFET detectors were 1.7 cGy (0.7-4.1 cGy) and 4.8 cGy (3.6-8.8 cGy), respectively. The TPS doses and MOSFET readings showed a significant strong correlation (Pearson r = 0.848, p < 0.001). The testicular doses measured by TPS (1.34 ± 0.36 cGy vs. 2.60 ± 0.95 cGy; p < 0.001) and MOSFET (4.52 ± 0.64 cGy vs. 6.56 ± 1.23 cGy; p < 0.001) were significantly lower in patients with prostate-only irradiation than in those with pelvic field irradiation. The mean cumulative scattered dose for prostate-only field delivering 78 Gy was 1.8 Gy and that for pelvic field irradiation was 2.6 Gy, consistent with the reported findings. CONCLUSIONS The patients with prostate-only irradiation received lower testicular doses than those with additional pelvic field irradiation possibly due to the increased scattered doses in large field irradiation using the VMAT technique. The clinical response to increased incidental testicular doses due to pelvic field irradiation remains unknown, and it warrants further investigation.
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Affiliation(s)
- Cem Onal
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey.
| | - Recep Bozca
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
| | - Yemliha Dolek
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
| | - Ozan Cem Guler
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
| | - Gungor Arslan
- Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
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Cho Y, Cho YJ, Chang WS, Kim JW, Choi WH, Lee IJ. Evaluation of optimal treatment planning for radiotherapy of synchronous bilateral breast cancer including regional lymph node irradiation. Radiat Oncol 2019; 14:56. [PMID: 30935400 PMCID: PMC6444509 DOI: 10.1186/s13014-019-1257-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background We evaluated the optimal radiotherapy (RT) plan for synchronous bilateral breast cancer (SBBC), especially treatment plans including the regional lymph node (LN) area. Methods This study was conducted using 15 patients with SBBC (5 with small breasts, 5 with large breasts, and 5 who underwent a left total mastectomy). The clinical target volume (CTV) was defined as the volume enveloping the bilateral whole breasts/chest wall and left regional LN area. We established the following plans: 1) volumetric-modulated arc therapy (VMAT)-the only plan using two pairs of partial arcs for the whole target volume, 2) VMAT using one partial arc for the left CTV followed by a 3D tangential technique for the right breast (primary hybrid plan), and 3) VMAT for the left CTV followed by a tangential technique using an automatically calculated prescription dose for the right breast, considering the background dose from the left breast VMAT plan (modified hybrid plan). The Tukey test and one-way analysis of variance were used to compare the target coverage and doses to organs at risk (OARs) of the three techniques. Results For target coverage, the VMAT-only and modified hybrid plans showed comparable target coverage in terms of Dmean (50.33 Gy vs. 50.53 Gy, p = 0.106). The primary hybrid plan showed the largest distribution of the high-dose volume, with V105% of 25.69% and V110% of 6.37% for the planning target volume (PTV) (p < 0.001). For OARs including the lungs, heart, and left anterior descending artery, the percentages of volume at various doses (V5Gy, V10Gy, V20Gy, V30Gy) and Dmean were significantly lower in both the primary and modified hybrid plans compared to those of the VMAT-only plan. These results were consistent in subgroup analyses of breast size and morphological variation. Conclusions The modified hybrid plan, using an automatically calculated prescription dose for the right breast and taking into consideration the background dose from the left breast VMAT plan, showed comparable target coverage to that of the VMAT-only plan, and was superior for saving OARs. However, considering that VMAT can be adjusted according to the physician’s intention, further evaluation is needed for developing a better plan. Electronic supplementary material The online version of this article (10.1186/s13014-019-1257-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Yoon Jin Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Won Suk Chang
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Won Hoon Choi
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
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Jiang A, Sun W, Zhao F, Wu Z, Shang D, Yu Q, Wang S, Zhu J, Yang F, Yuan S. Dosimetric evaluation of four whole brain radiation therapy approaches with hippocampus and inner ear avoidance and simultaneous integrated boost for limited brain metastases. Radiat Oncol 2019; 14:46. [PMID: 30876444 PMCID: PMC6419811 DOI: 10.1186/s13014-019-1255-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/07/2019] [Indexed: 01/31/2023] Open
Abstract
AIMS To perform a dosimetric evaluation of four different simultaneous integrated boost whole brain radiotherapy modalities with hippocampus and inner ear avoidance in the treatment of limited brain metastases. METHODS Computed tomography/magnetic resonance imaging data of 10 patients with limited (1-5) brain metastases were used to replan step-and-shoot intensity-modulated radiotherapy (sIMRT), dynamic intensity-modulated radiation therapy (dIMRT), volumetric-modulated arc therapy (VMAT), and helical tomotherapy (Tomo). The prescribed doses of 40-50 Gy in 10 fractions and 30 Gy in 10 fractions were simultaneously delivered to the metastatic lesions and the whole-brain volume, respectively. The hippocampal dose met the RTOG 0933 criteria for hippocampal avoidance (Dmax ≤17 Gy, D100% ≤10 Gy). The inner ear dose was restrained to Dmean ≤15 Gy. Target coverage (TC), homogeneity index (HI), conformity index (CI), maximum dose (Dmax), minimum dose (Dmin) and dose to organs at risk (OARs) were compared. RESULTS All plans met the indicated dose restrictions. The mean percentage of planning target volume of metastases (PTVmets) coverage ranged from 97.1 to 99.4%. For planning target volume of brain (PTVbrain), Tomo provided the lowest average D2% (37.5 ± 2.8 Gy), the highest average D98% (25.2 ± 2.0 Gy), and the best TC (92.6% ± 2.1%) and CI (0.79 ± 0.06). The two fixed gantry IMRT modalities (step and shot, dynamic) provided similar PTVbrain dose homogeneity (both 0.76). Significant differences across the four approaches were observed for the maximum and minimum doses to the hippocampus and the maximum doses to the eyes, lens and optic nerves. CONCLUSION All four radiotherapy modalities produced acceptable treatment plans with good avoidance of the hippocampus and inner ear. Tomo obtained satisfactory PTVbrain coverage and the best homogeneity index. TRIAL REGISTRATION Clinicaltrials.gov, NCT03414944 . Registered 29 January 2018.
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Affiliation(s)
- Aijun Jiang
- Shandong University, Jinan, 250117, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Weipeng Sun
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Fen Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Zhenxuan Wu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Dongping Shang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Qingxi Yu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Suzhen Wang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Jian Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Fengchang Yang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China.
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Miki K, Hioki K, Nakashima T, Saito A, Murakami Y, Kimura T, Nishibuchi I, Nagata Y. Development of geometrically ideal dose distribution as a reference for treatment planning in VMAT using filtered back-projection method. Phys Med 2019; 57:115-22. [PMID: 30738515 DOI: 10.1016/j.ejmp.2018.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/10/2018] [Accepted: 12/25/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine optimal dose distribution in the treatment planning of volumetric modulated arc therapy (VMAT), a virtually ideal dose distribution was developed as a reference by applying filtered back-projection method. METHODS Delineated structures in patient CT scans were identified using a treatment planning system. The projection of the planning target volume (PTV) was calculated along the X-ray direction for each angle of rotation. Each projection was Fourier transformed to the frequency space; a Shepp-Logan filter was applied, then an inverse Fourier transformation was performed. As the dose irradiation cannot assume a negative value, the filtered projections were shifted using the minimum value inside of the PTV. All values outside of the PTV were set to zero. The corrected filtered projections were then multiplied by the tissue-maximum ratio according to each voxel depth from the surface of the body to simulate X-ray attenuation. Finally, the distributions of multiple rotational angles were convolved to simulate the dose distribution of the VMAT. RESULTS Ideal dose distributions were generated with sufficient uniformity inside of the PTV. Dose spreading except for the PTV due to external irradiation was reproduced in the case of a brain tumor. A reference dose distribution including OAR sparing was produced. The efficacy of this process as a target for optimum planning was confirmed. CONCLUSION Using applied filtered back-projection, the ideal dose distribution, which excluded some device-oriented restrictions, was generated. This application will provide support for the determination of VMAT planning quality by providing reference dose distributions.
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Tanabe Y, Ishida T, Eto H, Sera T, Emoto Y. Evaluation of the correlation between prostatic displacement and rectal deformation using the Dice similarity coefficient of the rectum. Med Dosim 2019; 44:e39-e43. [PMID: 30642696 DOI: 10.1016/j.meddos.2018.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/07/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Abstract
To estimate the relationship between the three-dimensional (3D) displacement error of the prostate and rectal deformation for reduction of deviation between the planned and treatment dose, using multiple acquisition planning CT (MPCT) and the Dice similarity coefficient (DSC) for rectal deformation for treatment of patients with prostate cancer. The 3D displacement error between the pelvic bone and a matching fiducial marker was calculated using MPCT in 24 patients who underwent prostate volumetric-modulated arc therapy for prostate cancer. We calculated the 3D displacement error between the pelvic bone and a matching fiducial marker on MPCT. The correlation of the 3D displacement error with the DSC of the rectum, calculated from MPCT images, was evaluated based on deformable image registration. The 3D displacement error of the prostate showed a slight correlation between MPCT and cone-beam computed tomography (adjusted r2 = 0.241). The 3D displacement error, based on the pelvic bone and a fiducial marker on MPCT images, showed a moderate correlation with the DSC of the rectum (adjusted r2 = 0.645) and was improved by a mean of 3.94 mm, based on MPCT, during the treatment period. The 3D displacement error on MPCT correlates with the 3D displacement error of daily cone-beam computed tomography; optimal selection of MPCT can potentially facilitate on-board setup of prostate patients to enable more accurate radiotherapy. The advance information of the 3D displacement error and rectal deformation is useful for optimal planning CT that can minimize the deviation between the planned dose and the treatment dose in patients receiving treatment for prostate cancer.
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Affiliation(s)
- Yoshinori Tanabe
- Department of Radiology, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan; Division of Health Sciences, Graduate School of Medicine, Osaka University, Yamadaoka, Suita 565-0871, Japan
| | - Takayuki Ishida
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Yamadaoka, Suita 565-0871, Japan.
| | - Hidetoshi Eto
- Department of Radiology, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Tatsuhiro Sera
- Department of Radiology, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Yuki Emoto
- Department of Radiology, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
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Correia D, Terribilini D, Zepter S, Pica A, Bizzocchi N, Volken W, Stieb S, Ahlhelm F, Herrmann E, Fix MK, Manser P, Aebersold DM, Weber DC. Whole-ventricular irradiation for intracranial germ cell tumors: Dosimetric comparison of pencil beam scanned protons, intensity-modulated radiotherapy and volumetric-modulated arc therapy. Clin Transl Radiat Oncol 2019; 15:53-61. [PMID: 30734001 PMCID: PMC6357692 DOI: 10.1016/j.ctro.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 10/29/2022] Open
Abstract
Background Whole-ventricular radiotherapy (WV-RT) followed by a boost to the tumor bed (WV-RT/TB) is recommended for intracranial germ cell tumors (IGCT). As the critical brain areas are mainly in the target volume vicinity, it is unclear if protons indeed substantially spare neurofunctional organs at risk (NOAR). Therefore, a dosimetric comparison study of WV-RT/TB was conducted to assess whether proton or photon radiotherapy achieves better NOAR sparing. Methods Eleven children with GCT received 24 Gy(RBE) WV-RT and a boost up to 40 Gy(RBE) in 25 fractions of 1.6 Gy(RBE) with pencil beam scanning proton therapy (PBS-PT). Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans were generated for these patients. NOAR were delineated and treatment plans were compared for target volume coverage (TVC), homogeneity index (HI), inhomogeneity coefficient (IC) and (N)OAR sparing. Results TVC was comparable for all three modalities. Compared to IMRT and VMAT, PBS-PT showed statistically significant optimized IC, as well as dose reduction, among others, in mean and integral dose to the: normal brain (-35.2%, -32.7%; -35.2%, -33.0%, respectively), cerebellum (-53.7%, -33.1%; -53.6%, -32.7%) and right temporal lobe (-14.5%, -31.9%; -14.7%, -29.9%). The Willis' circle was better protected with PBS-PT than IMRT (-7.1%; -7.8%). The left hippocampus sparing was higher with IMRT. Compared to VMAT, the dose to the hippocampi, amygdalae and temporal lobes was significantly decreased in the IMRT plans. Conclusions Dosimetric comparison of WV-RT/TB in IGCT suggests PBS-PT's advantage over photons in conformality and NOAR sparing, whereas IMRT's superiority over VMAT, thus potentially minimizing long-term sequelae.
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Affiliation(s)
- Dora Correia
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Aargau, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Dario Terribilini
- Division of Medical Radiation Physics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stefan Zepter
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Aargau, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Aargau, Switzerland
| | - Nicola Bizzocchi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Aargau, Switzerland
| | - Werner Volken
- Division of Medical Radiation Physics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sonja Stieb
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Frank Ahlhelm
- Department of Radiology, Cantonal Hospital Baden, Baden, Aargau, Switzerland
| | - Evelyn Herrmann
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Michael K Fix
- Division of Medical Radiation Physics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Aargau, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Chung JH, Na K, Kim IH. Benefit of volumetric-modulated arc therapy over three-dimensional conformal radiotherapy for stage I-II extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue in the stomach: a dosimetric comparison. Radiat Oncol J 2018; 36:332-340. [PMID: 30630272 PMCID: PMC6361246 DOI: 10.3857/roj.2018.00402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose To retrospectively analyze dosimetric parameters of volumetric-modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3D-CRT) delivered to extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue in the stomach (gastric MALT lymphoma) to find out advantages of VMAT and conditions for definite benefits of VMAT. Materials and Methods Fifty patients with stage I-II gastric MALT lymphoma received VMAT (n = 14) or 3D-CRT (n = 36) between December 2005 and April 2018. Twenty-seven patients were categorized according to whether the planning target volume (PTV) overlaps kidney(s). Dosimetric parameters were analyzed by dose-volume histogram. Results Radiation dose to the liver was definitely lower with VMAT in terms of mean dose (p = 0.026) and V15 (p = 0.008). The V15 of the left kidney was lower with VMAT (p = 0.065). For those with PTV overlapping kidney(s), the left kidney V15 was significantly lower with VMAT. Furthermore, the closer the distance between the PTV and kidneys, the less the left kidney V15 with VMAT (p = 0.037). Delineation of kidney(s) by integrating all respiratory phases had no additional benefit. conclusions VMAT significantly increased monitor units, reduced treatment time and radiation dose to the liver and kidneys. The benefit of VMAT was definite in reducing the left kidney V15, especially in geometrically challenging conditions of overlap or close separation between PTV and kidney(s).
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Affiliation(s)
- Joo-Hyun Chung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoungsu Na
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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25
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Tandon S, Gairola M, Ahlawat P, Sharma K, Barik S, Sachdeva N, Pasricha S, Shenoy A. Sinonasal teratocarcinosarcoma treated with surgery followed by volumetric modulated radiotherapy: a case report with review of literature. Radiat Oncol J 2018; 36:341-347. [PMID: 30518169 PMCID: PMC6361250 DOI: 10.3857/roj.2018.00304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/02/2018] [Indexed: 11/22/2022] Open
Abstract
Surgical excision along with use of postoperative radiotherapy forms an integral management of sinonasal teratocarcinosarcoma (SNTCS). However, given the rarity of the tumor, no standardised guidelines, dose, technique and target delineation exist especially in the era of modern radiation delivery techniques. This is a case of 55-year-old male diagnosed as SNTCS treated with radical ethmoidectomy followed by volumetric modulated radiotherapy, showing good local control and acceptable toxicity profile.
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Affiliation(s)
- Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kanika Sharma
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Soumitra Barik
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Nishtha Sachdeva
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Apeksha Shenoy
- Department of Radiology and Imaging, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Rozanec N, Allibhai Z, Bhatti M, Chan E, McIntosh M, Moseley D, Taremi M, Abbas A. Palliation of Vertebral Metastases with Radiotherapy: Exploration of Volumetric-Modulated Arc Therapy From Development to Implementation in Routine Clinical Practice. J Med Imaging Radiat Sci 2018; 50:68-73. [PMID: 30777251 DOI: 10.1016/j.jmir.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 08/20/2018] [Accepted: 09/06/2018] [Indexed: 12/25/2022]
Abstract
The development of volumetric-modulated arc therapy (VMAT) in radiation therapy has allowed for improved dose escalation and a decrease in radiation-induced toxicities for patients. This article will describe a single centre's experience in development and implementation of VMAT for palliation of vertebral metastases. A retrospective planning analysis of 10 cases identified that utilization of VMAT decreases overall planning time with a statistically significant improvement in target coverage when compared with the current conventional technique. PTV Dmax (P = .02), PTV V9519Gy (95%) (P = .01), dose conformation (P = 1.8e-004), and the homogeneity index (P = .019) were all superior for VMAT plans with an average PTV length of 22.46 cm. Another benefit of VMAT utilization is a significant decrease in treatment delivery time, which reduced treatment times from 9.95 minutes to 2.98 minutes. Immobilization was also carefully considered, and rotational errors were measured and fell within institutional tolerances when VMAT was delivered using simple immobilization devices. Clinical implementation of this technique, utilizing a highly conformal target volume to decrease radiation-induced toxicities and minimizing the length of time patients are required to maintain their treatment positions, aims to improve the palliative radiotherapy experience for patients with painful spinal metastases.
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Affiliation(s)
- Natalie Rozanec
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; Sheffield Hallam University, Sheffield, United Kingdom.
| | - Zishan Allibhai
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; The Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Michael Bhatti
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Edwin Chan
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Marlyn McIntosh
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Douglas Moseley
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; The Princess Margaret Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Taremi
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; The Princess Margaret Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Ahmar Abbas
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
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Miguel-Chumacero E, Currie G, Johnston A, Currie S. Effectiveness of Multi-Criteria Optimization-based Trade-Off exploration in combination with RapidPlan for head & neck radiotherapy planning. Radiat Oncol 2018; 13:229. [PMID: 30470254 PMCID: PMC6251185 DOI: 10.1186/s13014-018-1175-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/06/2018] [Indexed: 11/11/2022] Open
Abstract
Background A new strategy is introduced combining the use of Multi-Criteria Optimization-based Trade-Off Exploration (TO) and RapidPlan™ (RP) for the selection of optimisation parameters that improve the trade-off between sparing of organs at risk (OAR) and target coverage for head and neck radiotherapy planning. Using both approaches simultaneously; three different workflows were proposed for the optimisation process of volumetric-modulated arc therapy (VMAT) plans. The generated plans were compared to the clinical plans and the plans that resulted using RP and TO individually. Methods Twenty clinical VMAT plans previously administered were selected. Five additional plans were created for each patient: a clinical plan further optimised with TO (Clin+TO); two plans generated by in-house built RP models, RP_1 with the model built with VMAT clinical plans and RP_TO with the model built with VMAT plans optimised by TO. Finally, these last two plans were additionally optimised with TO for the creation of the plans RP_1 + TO and RP_TO+ respectively. The TO management was standardised to maximise the sparing of the parotid glands without compromising a clinically acceptable PTV coverage. Resulting plans were inter-compared based on dose-volume parameters for OAR and PTVs, target homogeneity, conformity, and plans complexity and deliverability. Results The plans optimised using TO in combination with RP showed significantly improved OAR sparing while maintaining comparable target dose coverage to the clinical plans. The largest OAR sparing compared to the clinical plans was achieved by the RP_TO+ plans, which reported a mean parotid dose average of 15.0 ± 4.6 Gy vs 22.9 ± 5.5 Gy (left) and 17.1 ± 5.0 Gy vs 24.8 ± 5.8 Gy (right). However, at the same time, RP_TO+ showed a slight dose reduction for the 99% volume of the nodal PTV and an increase for the 95% (when comparing to the clinical plans 76.0 ± 1.2 vs 77.4 ± 0.6 and 80.9 ± 0.9 vs 79.7 ± 0.4) but remained within clinical acceptance. Plans optimised with RP and TO combined, showed an increase in complexity but were proven to be deliverable. Conclusion The use of TO combined with RP during the optimisation of VMAT plans enhanced plan quality the most. For the RP_TO+ plans, acceptance of a slight deterioration in nodal PTV allowed the largest reduction in OAR dose to be achieved.
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Affiliation(s)
- Eliane Miguel-Chumacero
- Beatson West of Scotland Cancer Centre, Radiotherapy Physics, NHS Greater Glasgow and Clyde, 1053 Great Western Road, Glasgow, G12 0YN, UK.
| | - Garry Currie
- Beatson West of Scotland Cancer Centre, Radiotherapy Physics, NHS Greater Glasgow and Clyde, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Abigail Johnston
- Beatson West of Scotland Cancer Centre, Radiotherapy Physics, NHS Greater Glasgow and Clyde, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Suzanne Currie
- Beatson West of Scotland Cancer Centre, Radiotherapy Physics, NHS Greater Glasgow and Clyde, 1053 Great Western Road, Glasgow, G12 0YN, UK
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Miki K, Saito A, Nakashima T, Murakami Y, Kimura T, Nishibuchi I, Nagata Y. Evaluation of optimization workflow using design of experiment (DoE) for various field configurations in volumetric-modulated arc therapy. Phys Med 2018; 54:34-41. [PMID: 30337008 DOI: 10.1016/j.ejmp.2018.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/14/2018] [Accepted: 09/20/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In volumetric-modulated arc therapy (VMAT), field configurations such as couch or arc angles are defined manually or using a template. A field configuration is reselected through trial-and-error in the case of undesirable resultant planning. To efficiently plan for desirable quality, configurations should be assessed before dose calculation. Design of experiments (DoE) is an optimization technique that efficiently reveals the influence of inputs on outputs. We developed an original tool using DoE to determine the field configuration selection and evaluated the efficacy of this workflow for clinical practice. METHODS Computed-tomography scans of 17 patients and target structures were acquired retrospectively from a brain tumor treated using a dual-arc VMAT plan. The configurations of the couch, arc, collimator angles, field sizes, and beam energy were determined using DoE. The resultant dose distributions obtained using the DoE-selected configuration were compared with the clinical plan. RESULTS The averaged differences between the DoE and clinical plan for 17 patients of doses to 50% of the planning target volume (PTV-D50%), Brain-D60%, Brain-D30%, Brain stem-D1%, Left eye-D1%, Right eye-D1%, Optic nerve-D1%, and Chiasm-D1% were 0.2 ± 0.5%, -1.0 ± 4.6%, 1.7 ± 3.5%, -2.5 ± 6.7%, -0.2 ± 4.9%, -1.2 ± 3.6%, -2.8 ± 7.3%, and -2.1 ± 5.7%, respectively. CONCLUSIONS Our optimization workflow obtained using DoE for various field configurations provided the same or slightly superior plan quality compared with that created by experts. This process is feasible for clinical practice and will efficiently improve treatment quality while removing the influence of the planner's experience.
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Affiliation(s)
- Kentaro Miki
- Department of Radiation Oncology, Hiroshima University Hospital, Japan.
| | - Akito Saito
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Takeo Nakashima
- Radiation Therapy Section, Department of Clinical Support, Hiroshima University Hospital, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
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Cho I, Park JW, Cho B, Kwak J, Yoon SM, Nesseler JP, Park J, Kim JH. Dosimetric analysis of stereotactic rotational versus static intensity-modulated radiation therapy for pancreatic cancer. Cancer Radiother 2018; 22:754-762. [PMID: 30322818 DOI: 10.1016/j.canrad.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/20/2018] [Accepted: 01/24/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Stereotactic body radiation therapy is a promising treatment modality for locally advanced pancreatic cancer. To determine the optimal radiation treatment, we compared the plan characteristics of volumetric-modulated arc therapy and intensity-modulated radiation therapy when administered with stereotactic body radiation therapy to treat pancreatic cancer. PATIENTS AND METHODS Fifteen patients with locally advanced pancreatic cancer were treated by stereotactic body radiation therapy at a dose of 24-32Gy in four fractions with marker-guided gated volumetric-modulated arc therapy. Four dimensional-computed tomography scans were used to assess the target and surrounding normal organs. The same images, contours, and dose constraints were used for dual-arc volumetric-modulated arc therapy and 9-field intensity-modulated radiation therapy planning. Plans were compared using dosimetric parameters and treatment performance. RESULTS Volumetric-modulated arc therapy required significantly lower monitor units (1726 vs. 4188; P<0.001) and shorter treatment delivery time in comparison with intensity-modulated radiation therapy (22.5min vs. 52.4min; P<0.001). Regarding target volume coverage, both modalities demonstrated comparable results (V95%, 99.3% vs. 99.4%; P=0.796). Both modalities satisfied the dosimetric determinants for duodenal toxicity and the maximum and mean doses administered to normal organ were also statistically similar. CONCLUSION In comparison with 9-field intensity-modulated radiation therapy, volumetric-modulated arc therapy significantly reduces the number of monitoring units and treatment delivery times while administering similar dosimetric quality. Based on these results, volumetric-modulated arc therapy might be an appropriate treatment for locally advanced pancreatic cancer when combined with stereotactic body radiation therapy.
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Affiliation(s)
- I Cho
- Division of Heavy-ion Clinical Research, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul, Republic of Korea
| | - J W Park
- Department of Radiation Oncology, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, Republic of Korea
| | - B Cho
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05505 Songpa-gu, Seoul, Republic of Korea
| | - J Kwak
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05505 Songpa-gu, Seoul, Republic of Korea
| | - S M Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05505 Songpa-gu, Seoul, Republic of Korea
| | - J P Nesseler
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - J Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05505 Songpa-gu, Seoul, Republic of Korea.
| | - J H Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 05505 Songpa-gu, Seoul, Republic of Korea
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Saw CB, Li S, Battin F, McKeague J, Peters CA. External beam planning module of Eclipse for external beam radiation therapy. Med Dosim 2018; 43:195-204. [PMID: 29753335 DOI: 10.1016/j.meddos.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 12/25/2022]
Abstract
Eclipse is a 3-dimensional (3D) treatment planning system for radiation therapy offered by Varian Medical Systems, Inc. The system has the network connectivity for the electronic transfer of image datasets and digital data communication among different equipment. The scope of this project for this special issue of Medical Dosimetry on 3D treatment planning systems is the assessment of planning tools in the external beam planning module of Eclipse to generate optimized treatment plans for patients undergoing external beam radiation therapy. This treatment planning system is relatively mature to be able to generate (1) simple treatment plans, (2) conformal radiation therapy plans, (3) static intensity-modulated radiation therapy (IMRT) plans, (4) volumetric-modulated arc therapy (VMAT) plans, and (5) treatment plans for electron beam therapy. The treatment planning tools are relatively plentiful to assist in the radiation therapy treatment planning. Some new features have been incorporated in the latest version and are helpful for making high-quality treatment plans. However, the location of the tools is not intuitive, and hence, familiarity with the user interface is essential to the efficient use of the treatment planning system. In addition, there are a number of dose algorithms available for the computation of dose distributions. The understanding of each dose computation algorithm is essential for the optimal use of this treatment planning system.
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Affiliation(s)
- Cheng B Saw
- Department of Radiation Oncology, Northeast Radiation Oncology Centers (NROC), Dunmore, PA 18512, USA.
| | - SiCong Li
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Frank Battin
- Department of Radiation Oncology, Northeast Radiation Oncology Centers (NROC), Dunmore, PA 18512, USA
| | - Janice McKeague
- Department of Radiation Oncology, Northeast Radiation Oncology Centers (NROC), Dunmore, PA 18512, USA
| | - Christopher A Peters
- Department of Radiation Oncology, Northeast Radiation Oncology Centers (NROC), Dunmore, PA 18512, USA
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Ahmad I, Chufal KS, Bashir I, Bhatt CP, Bajpai R, Sharma L, Rathour S. Early Clinical Outcomes, Patterns of Failure, and Acute Haematologic Toxicity of Image-Guided Volumetric Modulated Arc Therapy (IG-VMAT) in the Definitive Treatment of Locally Advanced Carcinoma Cervix. Clin Med Insights Oncol 2018; 12:1179554918783990. [PMID: 30093800 PMCID: PMC6081749 DOI: 10.1177/1179554918783990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 05/22/2018] [Indexed: 11/21/2022]
Abstract
Purpose: To evaluate clinical outcomes and failure patterns in patients with locally
advanced cervical cancer (LACC) treated definitively using image-guided
volumetric-modulated arc therapy (IG-VMAT). Methods and materials: This retrospective review included 18 consecutively treated patients with
LACC. Treatment consisted of IG-VMAT and concurrent chemotherapy followed by
intracavitary radiotherapy. The primary end points were overall survival
(OS) and disease-free survival (DFS). Acute haematologic toxicity was
evaluated using Radiation Therapy Oncology Group (RTOG) criteria. Results: A total of 16 patients were either stage IIB or IIIB and the median follow-up
was 30.5 months (interquartile range: 13-36.25 months). The 2-year DFS was
63.3% (95% confidence interval [CI]: 52.8%-72.4%) and 2-year OS was 72.2%
(95% CI: 62.1%-80.5%). There were 7 treatment failures, predominantly
in-field. Acute haematologic toxicity was low. Conclusions: IG-VMAT is associated with favourable outcomes for patients with LACC.
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Affiliation(s)
- Irfan Ahmad
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
| | - Kundan Singh Chufal
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute & Research Centre, Rohini, New Delhi, India
| | - Irfan Bashir
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
| | - Chandi Prasad Bhatt
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
| | - Ram Bajpai
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lalit Sharma
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
| | - Sandeep Rathour
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
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Zhang Y, Wang H, Huang X, Zhang Q, Ren R, Sun R, Zheng Z, Dong S, Zheng A. Dosimetric comparison of TomoDirect, helical tomotherapy, VMAT, and ff-IMRT for upper thoracic esophageal carcinoma. Med Dosim 2018; 44:167-172. [PMID: 29950277 DOI: 10.1016/j.meddos.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/08/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The new TomoDirect (TD) modality offers a nonrotational option with discrete beam angles. We aim to compare dosimetric parameters of TD, helical tomotherapy (HT), volumetric-modulated arc therapy (VMAT), and fixed-field intensity-modulated radiotherapy (ff-IMRT) for upper thoracic esophageal carcinoma (EC). METHODS Twenty patients with cT2-4N0-1M0 upper thoracic esophageal squamous cell carcinoma (ESCC) were enrolled. Four plans were generated using the same dose objectives for each patient: TD, HT, VMAT with a single arc, and ff-IMRT with 5 fields (5F). The prescribed doses were used to deliver 50.4 Gy/28F to the planning target volume (PTV50.4) and then provided a 9 Gy/5F boost to PTV59.4. Dose-volume histogram (DVH) statistics, dose uniformity, and dose homogeneity were analyzed to compare treatment plans. RESULTS For PTV59.4, the D2, D98, Dmean, and V100% values in HT were significantly lower than other plans (all p < 0.05), and those in TD were significantly lower than VMAT and ff-IMRT (all p < 0.05). However, there was no significant difference in the D2 and Dmean values between VMAT and ff-IMRT techniques (p > 0.05). The homogeneity index (HI) differed significantly for the 4 techniques of TD, HT, VMAT, and ff-IMRT (0.03 ± 0.01, 0.02 ± 0.01, 0.06 ± 0.02, and 0.05 ± 0.01, respectively; p < 0.001). The HI for TD was similar to HT (p = 0.166), and had statistically significant improvement compared to VMAT (p < 0.001) and ff-IMRT (p = 0.003). In comparison with the 4 conformity indices (CIs), there was no significant difference (p > 0.05). For PTV50.4, the D2 and Dmean values in HT were significantly lower than other plans (all p < 0.05), and those in TD were significantly lower than VMAT and ff-IMRT (all p < 0.05). However, there was no significant difference in the D2 and Dmean values between VMAT and ff-IMRT techniques (p > 0.05). No D98 and V100% parameters differed significantly among the 4 treatment types (p > 0.05). HT plans were provided for statistically significant improvement in HI (0.03 ± 0.01) compared to TD plans (0.05 ± 0.01, p = 0.003), VMAT (0.08 ± 0.03, p < 0.001), ff-IMRT (0.08 ± 0.01, p < 0.001). The HI revealed that TD was superior to VMAT and ff-IMRT (p < 0.05). The CI differed significantly for the 4 techniques of TD, HT, VMAT, and ff-IMRT (0.59 ± 0.10, 0.69 ± 0.11, 0.64 ± 0.09, and 0.64 ± 0.11, respectively; p = 0.035). The best CI was yielded by HT. We found no significant difference for the V5, V10, V15, V30, and the mean lung dose (MLD) among the 4 techniques (all p > 0.05). However, the V20 differed significantly among TD, HT, VMAT, and ff-IMRT (21.50 ± 7.20%, 19.50 ± 5.55%, 17.65 ± 5.45%, and 16.35 ± 5.70%, respectively; p = 0.047). Average V20 for the lungs was significantly improved by the TD plans compared to VMAT (p = 0.047), and ff-IMRT (p = 0.008). The V5 value of the lung in TD was 49.30 ± 13.01%, lower than other plans, but there was no significant difference (p > 0.05). The D1 of the spinal cord showed no significant difference among the 4 techniques (p = 0.056). CONCLUSIONS All techniques are able to provide a homogeneous and highly conformal dose distribution. The TD technique is a good option for treating upper thoracic EC involvement. It could achieve optimal low dose to the lungs and spinal cord with acceptable PTV coverage. HT is a good option as it could achieve quality dose conformality and uniformity, while TD generated superior conformality.
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Affiliation(s)
- Yaowen Zhang
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Huitao Wang
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Xiao Huang
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Qiang Zhang
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Runchuan Ren
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Ronggang Sun
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Zhiyong Zheng
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Shangwen Dong
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China.
| | - Anping Zheng
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China.
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Wang J, Chen Z, Li W, Qian W, Wang X, Hu W. A new strategy for volumetric-modulated arc therapy planning using AutoPlanning based multicriteria optimization for nasopharyngeal carcinoma. Radiat Oncol 2018; 13:94. [PMID: 29769101 PMCID: PMC5956620 DOI: 10.1186/s13014-018-1042-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A new strategy for making the appropriate choice of the representative optimization parameters in planning processes and accurate selection criteria during Pareto surface navigation for general multicriteria optimization (MCO) was recommended in the study. The purpose was to combine both benefits of AutoPlanning optimization and MCO (APMCO) for achieving an individual volumetric-modulated arc therapy (VMAT) plan according to the clinically achieved patient-specific tradeoff among conflicting priorities. The preclinical investigation of this optimization approach for nasopharyngeal carcinoma (NPC) radiotherapy was performed and compared to general MCO VMAT. METHODS A total of 60 NPC patients with various stages were enrolled in this study. General MCO and APMCO plans were generated for each patient on the treatment planning system. The differences between two planning schemes were evaluated and compared. RESULTS All plans were capable of achieving the prescription requirement. The planning target volume coverage and conformation number were remarkably similar between general MCO and APMCO plans. There were no significant differences in most of organs at risk (OARs) sparing. However, in APMCO plans, relatively remarkable decreases were observed in the mean dose (Dmean) to the glottic larynx and pharyngeal constrictor muscles. The reductions of average Dmean to the two OARs were 10.5% (p < 0.0001) and 8.4% (p < 0.0001), respectively. APMCO technique was found to increase the planning time for an average of approximately 5 h and did not lead to a significant increase of monitor units compared to general MCO. CONCLUSIONS The potential of the APMCO strategy is best realized with a clinical implementation that exploits individual generation of Pareto surface representations without manual interaction. It also assists physicians to ensure navigation in a more efficient and straightforward manner.
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Affiliation(s)
- Juanqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhi Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiwei Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Qian
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaosheng Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Jeong Y, Jung J, Cho B, Kwak J, Jeong C, Kim JH, Park JH, Kim SY, Shim JH, Kim KM, Lim YS, Lee HC, Yoon SM. Stereotactic body radiation therapy using a respiratory-gated volumetric-modulated arc therapy technique for small hepatocellular carcinoma. BMC Cancer 2018; 18:416. [PMID: 29653562 PMCID: PMC5899378 DOI: 10.1186/s12885-018-4340-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/08/2018] [Indexed: 12/23/2022] Open
Abstract
Background Volumetric-modulated arc therapy (VMAT) is a highly sophisticated linear accelerator-based treatment method, and allows dose rate-changing intensity modulation with gantry rotation. We report our clinical experiences with stereotactic body radiation therapy (SBRT) using a respiratory-gated VMAT technique for patients with hepatocellular carcinoma (HCC) when established curative treatments cannot be applied. Methods A total of 119 patients (139 lesions) with HCC who were treated with SBRT were registered between March 2012 and July 2013 at our institution. A dose of 10–15 Gy per fraction was applied over 3–4 consecutive days, resulting in a total dose of 30–60 Gy. Results The median follow-up period was 25.8 months (range, 3.2–36.8 months). The overall 3-year survival rate was 83.8%. The local control rate at 3 years was 97.0% in all treated lesions. Multivariate analysis revealed that the Child-Pugh class before SBRT had significant effects on overall survival (Child-Pugh A: hazard ratio = 0.463; 95% CI, 0.262–0.817; p = 0.008). Conclusions SBRT using a respiratory-gated VMAT technique was an excellent ablative treatment modality for patients with HCC. SBRT is a good alternative treatment for patients with small HCCs that are unsuitable for surgical resection or local ablative therapy. Electronic supplementary material The online version of this article (10.1186/s12885-018-4340-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuri Jeong
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Byungchul Cho
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jungwon Kwak
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Chiyoung Jeong
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jong Hoon Kim
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kang Mo Kim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han Chu Lee
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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Didona A, Lancellotta V, Zucchetti C, Panizza BM, Frattegiani A, Iacco M, Di Pilato AC, Saldi S, Aristei C. Is volumetric modulated arc therapy with constant dose rate a valid option in radiation therapy for head and neck cancer patients? Rep Pract Oncol Radiother 2018; 23:175-182. [PMID: 29765265 DOI: 10.1016/j.rpor.2018.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/17/2018] [Accepted: 02/16/2018] [Indexed: 01/17/2023] Open
Abstract
Background Intensity-modulated radiotherapy (IMRT) improves dose distribution in head and neck (HN) radiation therapy. Volumetric-modulated arc therapy (VMAT), a new form of IMRT, delivers radiation in single or multiple arcs, varying dose rates (VDR-VMAT) and gantry speeds, has gained considerable attention. Constant dose rate VMAT (CDR-VMAT) associated with a fixed gantry speed does not require a dedicated linear accelerator like VDR-VMAT. The present study explored the feasibility, efficiency and delivery accuracy of CDR-VMAT, by comparing it with IMRT and VDR-VMAT in treatment planning for HN cancer. Methods and materials Step and shoot IMRT (SS-IMRT), CDR-VMAT and VDR-VMAT plans were created for 15 HN cancer patients and were generated by Pinnacle3 TPS (v 9.8) using 6 MV photon energy. Three PTVs were defined to receive respectively prescribed doses of 66 Gy, 60 Gy and 54 Gy, in 30 fractions. Organs at risk (OARs) included the mandible, spinal cord, brain stem, parotids, salivary glands, esophagus, larynx and thyroid. SS-IMRT plans were based on 7 co-planar beams at fixed gantry angles. CDR-VMAT and VDR-VMAT plans, generated by the SmartArc module, used a 2-arc technique: one clockwise from 182° to 178° and the other one anti-clockwise from 178° to 182°. Comparison parameters included dose distribution to PTVs (Dmean, D2%, D50%, D95%, D98% and Homogeneity Index), maximum or mean doses to OARs, specific dose-volume data, the monitor units and treatment delivery times. Results Compared with SS-IMRT, CDR-VMAT significantly reduced the maximum doses to PTV1 and PTV2 and significantly improved all PTV3 parameters, except D98% and D95%. It significantly spared parotid and submandibular glands and was associated with a lower Dmean to the larynx. Compared with VDR-VMAT, CDR-VMAT was linked to a significantly better Dmean, to the PTV3 but results were worse for the parotids, left submandibular gland, esophagus and mandible. Furthermore, the Dmean to the larynx was also worse. Compared with SS-IMRT and VDR-VMAT, CDR-VMAT was associated with higher average monitor unit values and significantly shorter average delivery times. Conclusions CDR-VMAT appeared to be a valid option in Radiation Therapy Centers that lack a dedicated linear accelerator for volumetric arc therapy with variable dose-rates and gantry velocities, and are unwilling or unable to sanction major expenditure at present but want to adopt volumetric techniques.
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Affiliation(s)
- Annamaria Didona
- Phys, Medical Physic Unit, Grosseto General Hospital, Grosseto, Italy
| | - Valentina Lancellotta
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Claudio Zucchetti
- Phys, Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | | | | | - Martina Iacco
- Phys, Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | | | - Simonetta Saldi
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
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Chen H, Wang H, Gu H, Shao Y, Cai X, Fu X, Xu Z. Study for reducing lung dose of upper thoracic esophageal cancer radiotherapy by auto-planning: volumetric-modulated arc therapy vs intensity-modulated radiation therapy. Med Dosim 2017; 43:243-250. [PMID: 29110926 DOI: 10.1016/j.meddos.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022]
Abstract
This study aimed to investigate the dosimetric differences and lung sparing between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) in the treatment of upper thoracic esophageal cancer with T3N0M0 for preoperative radiotherapy by auto-planning (AP). Sixteen patient cases diagnosed with upper thoracic esophageal cancer T3N0M0 for preoperative radiotherapy were retrospectively studied, and 3 plans were generated for each patient: full arc VMAT AP plan with double arcs, partial arc VMAT AP plan with 6 partial arcs, and conventional IMRT AP plan. A simultaneous integrated boost with 2 levels was planned in all patients. Target coverage, organ at risk sparing, treatment parameters including monitor units and treatment time (TT) were evaluated. Wilcoxon signed-rank test was used to check for significant differences (p < 0.05) between datasets. VMAT plans (pVMAT and fVMAT) significantly reduced total lung volume treated above 20 Gy (V20), 25 Gy (V25), 30 Gy (V30), 35 Gy (V35), 40 Gy (V40), and without increasing the value of V10, V13, and V15. For V5 of total lung value, pVMAT was similar to aIMRT, and it was better than fVMAT. Both pVMAT and fVMAT improved the target dose coverage and significantly decreased maximum dose for the spinal cord, monitor unit, and TT. No significant difference was observed with respect to V10 and V15 of body. VMAT AP plan was a good option for treating upper thoracic esophageal cancer with T3N0M0, especially partial arc VMAT AP plan. It had the potential to effectively reduce lung dose in a shorter TT and with superior target coverage and dose homogeneity.
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Affiliation(s)
- Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hengle Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xuwei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
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Xu LM, Kang ML, Jiang B, Liu QF, Li YX. A study of the dosimetric characteristics between different fixed-field IMRT and VMAT in early-stage primary mediastinal B-cell lymphoma. Med Dosim 2017; 43:91-99. [PMID: 28935521 DOI: 10.1016/j.meddos.2017.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
This analysis was designed to compare dosimetric parameters among different fixed-field intensity-modulated radiation therapy (IMRT) solutions and volumetric-modulated arc therapy (VMAT) to identify which can achieve the lowest risk of organs at risk (OARs) and treatment delivery efficiently. A total of 16 patients (8 male and 8 female) with early-stage primary mediastinal large B-cell lymphoma (PMBCL) were enrolled with planned gross tumor volume (PGTV) 45 Gy and planning target volume (PTV) 40 Gy. Four different plans were generated: 5-, 7, 9-field IMRT, and VMAT. The dose distributions for PGTV and PTV OARs (lungs, left ventricle, heart, thyroid gland, and breasts) were compared. The monitor units (MUs) and treatment delivery time were also evaluated. Mean conformity index (CI) and homogeneity index (HI) for PGTV in 5F-, 7F-, 9F-IMRT, and VMAT were 1.01 and 1.10, 1.01 and 1.10, 1.01 and 1.10, and 1.01 and 1.11 (p = 0.963 and 0.843), whereas these 2 indices for PTV were 1.04 and 1.22, 1.03 and 1.19, 1.03 and 1.17, and 1.08 and 1.14 (p = 0.964 and 0.969), respectively. Dmean (Gy), V4 (%), D50 (Gy), and D80 (Gy) to the left and right breasts increased by 0.7 Gy and 0.1 Gy, 6.8% and 7.7%, 0.9 Gy and 1.7 Gy, and 1.0 Gy and 1.5 Gy in VMAT, respectively. The 9-beam IMRT plan had the highest MUs (25,762.4 MUs) and the longest treatment delivery time (10.7 minutes); whereas, the VMAT had the lowest MUs (13,345.0) and the shortest treatment delivery time (5.9 minutes). Seven- and 9-field IMRT and VMAT provide improved tumor coverage compared with 5F-IMRT, whereas VMAT shows higher treatment delivery efficiency than IMRT technique. Seven- and 9-field IMRT slightly reduce the low dose radiation exposure of breasts compared with VMAT technique. The 7- and 9-field IMRT and VMAT techniques both can be safely and efficiently delivered to patients with PMBCL.
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Affiliation(s)
- Li-Ming Xu
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China; Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China.
| | - Ming-Lei Kang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China; Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Bo Jiang
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qing-Feng Liu
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China.
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Sood S, Pokhrel D, McClinton C, Lominska C, Badkul R, Jiang H, Wang F. Volumetric-modulated arc therapy (VMAT) for whole brain radiotherapy: not only for hippocampal sparing, but also for reduction of dose to organs at risk. Med Dosim 2017; 42:375-383. [PMID: 28822604 DOI: 10.1016/j.meddos.2017.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/08/2017] [Accepted: 07/10/2017] [Indexed: 11/26/2022]
Abstract
A prospective clinical trial, Radiation Therapy Oncology Group (RTOG) 0933, has demonstrated that whole brain radiotherapy (WBRT) using conformal radiation delivery technique with hippocampal avoidance is associated with less memory complications. Further sparing of other organs at risk (OARs) including the scalp, ear canals, cochleae, and parotid glands could be associated with reductions in additional toxicities for patients treated with WBRT. We investigated the feasibility of WBRT using volumetric-modulated arc therapy (VMAT) to spare the hippocampi and the aforementioned OARs. Ten patients previously treated with nonconformal WBRT (NC-WBRT) using opposed lateral beams were retrospectively re-planned using VMAT with hippocampal sparing according to the RTOG 0933 protocol. The OARs (scalp, auditory canals, cochleae, and parotid glands) were considered as dose-constrained structures. VMAT plans were generated for a prescription dose of 30 Gy in 10 fractions. Comparison of the dosimetric parameters achieved by VMAT and NC-WBRT plans was performed using paired t-tests using upper bound p-value of < 0.001. Average beam on time and monitor units (MUs) delivered to the patients on VMAT were compared with those obtained with NC-WBRT. All VMAT plans met RTOG 0933 dosimetric criteria including the dose to hippocampi of 100% of the volume (D100%) of 8.4 ± 0.3 Gy and maximum dose of 15.6 ± 0.4 Gy, respectively. A statistically significant dose reduction (p < 0.001) to all OARs was achieved. The mean and maximum scalp doses were reduced by an average of 9 Gy (32%) and 2 Gy (6%), respectively. The mean and maximum doses to the auditory canals were reduced from 29.5 ± 0.5 Gy and 31.0 ± 0.4 Gy with NC-WBRT, to 21.8 ± 1.6 Gy (26%) and 27.4 ± 1.4 Gy (12%) with VMAT. VMAT also reduced mean and maximum doses to the cochlea by an average of 4 Gy (13%) and 2 Gy (6%), respectively. The parotid glands mean and maximum doses with VMAT were 4.4 ± 1.9 Gy and 15.7 ± 5.0 Gy, compared to 12.8 ± 4.9 Gy and 30.6 ± 0.5 Gy with NC-WBRT, respectively. The average dose reduction of mean and maximum of parotid glands from VMAT were 65% and 50%, respectively. The average beam on time and MUs were 2.3minutes and 719 on VMAT, and 0.7 minutes and 350 on NC-WBRT. This study demonstrated the feasibility of WBRT using VMAT to not only spare the hippocampi, but also significantly reduce dose to OARs. These advantages of VMAT could potentially decrease the toxicities associated with NC-WBRT and improve patients' quality of life, especially for patients with favorable prognosis receiving WBRT or patients receiving prophylactic cranial irradiation (PCI).
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Affiliation(s)
- Sumit Sood
- Department of Radiation Oncology, The University of Kansas Cancer Center, Kansas City, KS, USA.
| | - Damodar Pokhrel
- Department of Radiation Oncology, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Christopher McClinton
- Department of Radiation Oncology, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Christopher Lominska
- Department of Radiation Oncology, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Rajeev Badkul
- Department of Radiation Oncology, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Hongyu Jiang
- Department of Radiation Oncology, The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Fen Wang
- Department of Radiation Oncology, The University of Kansas Cancer Center, Kansas City, KS, USA
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Abstract
The treatment of anal cancer has evolved remarkably in the past 30 years. Definitive chemoradiotherapy is the standard of care, allowing organ preservation and maintenance of continence for most patients. This article reviews recent advances in radiotherapy planning and delivery that have resulted in improvements in treatment-related toxicity. Most notably, the advent and wide adoption of intensity-modulated radiotherapy provides a superior toxicity profile compared with older techniques, while maintaining similar oncologic outcomes. Current areas of active research include optimizing and individualizing treatment intensity and possible integration of biologic agents and immunotherapies in the treatment of anal cancer.
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Affiliation(s)
- Serguei A Castaneda
- Department of Radiation Oncology, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, 4701 Ogletown-Stanton RR, S-1110, Newark, DE 19713, USA; Department of Radiation Oncology, Drexel University College of Medicine, 245 North 15th Street, MS #200, Philadelphia, PA 19102, USA
| | - Lindsay B Romak
- Department of Radiation Oncology, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, 4701 Ogletown-Stanton RR, S-1110, Newark, DE 19713, USA.
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Della Gala G, Dirkx MLP, Hoekstra N, Fransen D, Lanconelli N, van de Pol M, Heijmen BJM, Petit SF. Fully automated VMAT treatment planning for advanced-stage NSCLC patients. Strahlenther Onkol 2017; 193:402-409. [PMID: 28314877 PMCID: PMC5405101 DOI: 10.1007/s00066-017-1121-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/03/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE To develop a fully automated procedure for multicriterial volumetric modulated arc therapy (VMAT) treatment planning (autoVMAT) for stage III/IV non-small cell lung cancer (NSCLC) patients treated with curative intent. MATERIALS AND METHODS After configuring the developed autoVMAT system for NSCLC, autoVMAT plans were compared with manually generated clinically delivered intensity-modulated radiotherapy (IMRT) plans for 41 patients. AutoVMAT plans were also compared to manually generated VMAT plans in the absence of time pressure. For 16 patients with reduced planning target volume (PTV) dose prescription in the clinical IMRT plan (to avoid violation of organs at risk tolerances), the potential for dose escalation with autoVMAT was explored. RESULTS Two physicians evaluated 35/41 autoVMAT plans (85%) as clinically acceptable. Compared to the manually generated IMRT plans, autoVMAT plans showed statistically significant improved PTV coverage (V95% increased by 1.1% ± 1.1%), higher dose conformity (R50 reduced by 12.2% ± 12.7%), and reduced mean lung, heart, and esophagus doses (reductions of 0.9 Gy ± 1.0 Gy, 1.5 Gy ± 1.8 Gy, 3.6 Gy ± 2.8 Gy, respectively, all p < 0.001). To render the six remaining autoVMAT plans clinically acceptable, a dosimetrist needed less than 10 min hands-on time for fine-tuning. AutoVMAT plans were also considered equivalent or better than manually optimized VMAT plans. For 6/16 patients, autoVMAT allowed tumor dose escalation of 5-10 Gy. CONCLUSION Clinically deliverable, high-quality autoVMAT plans can be generated fully automatically for the vast majority of advanced-stage NSCLC patients. For a subset of patients, autoVMAT allowed for tumor dose escalation.
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Affiliation(s)
- Giuseppe Della Gala
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands.,Scuola di Scienze, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Maarten L P Dirkx
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands.
| | - Nienke Hoekstra
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands
| | - Dennie Fransen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands
| | - Nico Lanconelli
- Scuola di Scienze, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Marjan van de Pol
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands
| | - Ben J M Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands
| | - Steven F Petit
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 5201, 3008 AE, Rotterdam, The Netherlands.,Department of Radiation Oncology, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
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Ostheimer C, Hübsch P, Janich M, Gerlach R, Vordermark D. Dosimetric comparison of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in total scalp irradiation: a single institutional experience. Radiat Oncol J 2016; 34:313-321. [PMID: 27951625 PMCID: PMC5207369 DOI: 10.3857/roj.2016.01935] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/22/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose Total scalp irradiation (TSI) is a rare but challenging indication. We previously reported that non-coplanar intensity-modulated radiotherapy (IMRT) was superior to coplanar IMRT in organ-at-risk (OAR) protection and target dose distribution. This consecutive treatment planning study compared IMRT with volumetric-modulated arc therapy (VMAT). Materials and Methods A retrospective treatment plan databank search was performed and 5 patient cases were randomly selected. Cranial imaging was restored from the initial planning computed tomography (CT) and target volumes and OAR were redelineated. For each patients, three treatment plans were calculated (coplanar/non-coplanar IMRT, VMAT; prescribed dose 50 Gy, single dose 2 Gy). Conformity, homogeneity and dose volume histograms were used for plan. Results VMAT featured the lowest monitor units and the sharpest dose gradient (1.6 Gy/mm). Planning target volume (PTV) coverage and homogeneity was better in VMAT (coverage, 0.95; homogeneity index [HI], 0.118) compared to IMRT (coverage, 0.94; HI, 0.119) but coplanar IMRT produced the most conformal plans (conformity index [CI], 0.43). Minimum PTV dose range was 66.8% –88.4% in coplanar, 77.5%–88.2% in non-coplanar IMRT and 82.8%–90.3% in VMAT. Mean dose to the brain, brain stem, optic system (maximum dose) and lenses were 18.6, 13.2, 9.1, and 5.2 Gy for VMAT, 21.9, 13.4, 14.5, and 6.3 Gy for non-coplanar and 22.8, 16.5, 11.5, and 5.9 Gy for coplanar IMRT. Maximum optic chiasm dose was 7.7, 8.4, and 11.1 Gy (non-coplanar IMRT, VMAT, and coplanar IMRT). Conclusion Target coverage, homogeneity and OAR protection, was slightly superior in VMAT plans which also produced the sharpest dose gradient towards healthy tissue.
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Affiliation(s)
- Christian Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Patrick Hübsch
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Martin Janich
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Reinhard Gerlach
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
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Zwahlen DR, Bischoff LI, Gruber G, Sumila M, Schneider U. Estimation of second cancer risk after radiotherapy for rectal cancer: comparison of 3D conformal radiotherapy and volumetric modulated arc therapy using different high dose fractionation schemes. Radiat Oncol 2016; 11:149. [PMID: 27832799 PMCID: PMC5103599 DOI: 10.1186/s13014-016-0723-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/27/2016] [Indexed: 12/16/2022] Open
Abstract
Purpose To investigate second cancer risk (SCR) comparing volumetric modulated arc therapy (VMAT) and 3D conformal radiotherapy (3DCRT) with different high dose fractionation schemes. Methods VMAT and 3DCRT virtual treatment plans for 25 patients previously treated with radiotherapy for rectal cancer were evaluated retrospectively. Doses prescribed were 25 × 1.8 Gy and 5 × 5 Gy, respectively. SCR was estimated using a carcinogenesis model and epidemiological data for carcinoma and sarcoma induction. SCR was determined by lifetime attributable risk (LAR). Results Mean excess LAR was highest for organs adjacent to the PTV. Total LAR for VMAT and 3DCRT was 2.3–3.0 and 2.0–2.7 %, respectively. For 5 × 5 Gy, LAR was 1.4–1.9 % for VMAT and 1.2–1.6 % for 3DCRT. Organ-specific excess LAR was significantly higher for VMAT, and highest for bladder and colon. Size and shape of the PTV influenced SCR and was highest for age ≤ 40 years. For a patient with an additional lifetime risk of 60 years, LAR was 10 % for 25 × 1.8 Gy and 6 % for 5 × 5 Gy. Conclusions No statistically significant difference was detected in SCR using VMAT or 3DCRT. For bladder and colon, organ-specific excess LAR was statistically lower using 3DCRT, however the difference was small. Compared to epidemiological data, SCR was smaller when using a hypofractionated schedule. SCR was 2 % higher at normal life expectancy. Trial registration ClinicalTrials.gov Identifier NCT02572362. Registered 4 October 2015. Retrospectively registered.
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Affiliation(s)
- Daniel R Zwahlen
- Department of Radiation Oncology, Kantonsspital Graubuenden, Chur, Switzerland. .,Department of Physics, University of Zurich, Zurich, Switzerland. .,Department of Radiation Oncology, Kantonsspital Graubuenden, Loestrasse 170, Chur, CH-7000, Switzerland.
| | - Laura I Bischoff
- Department of Physics, University of Zurich, Zurich, Switzerland
| | - Günther Gruber
- Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Marcin Sumila
- Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Uwe Schneider
- Department of Physics, University of Zurich, Zurich, Switzerland.,Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
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McQuaid D, Dunlop A, Nill S, Franzese C, Nutting CM, Harrington KJ, Newbold KL, Bhide SA. Evaluation of radiotherapy techniques for radical treatment of lateralised oropharyngeal cancers : Dosimetry and NTCP. Strahlenther Onkol 2016; 192:516-25. [PMID: 27295511 DOI: 10.1007/s00066-016-0980-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/12/2016] [Indexed: 12/22/2022]
Abstract
AIM The aim of this study was to investigate potential advantages and disadvantages of three-dimensional conformal radiotherapy (3DCRT), multiple fixed-field intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in terms of dose to the planning target volume (PTV), organs at risk (OARs) and normal tissue complication probability (NTCP) for delivering ipsilateral radiotherapy. MATERIALS AND METHODS 3DCRT, IMRT and VMAT were compared in patients with well-lateralised primary tonsillar cancers who underwent primary radical ipsilateral radiotherapy. The following parameters were compared: conformity index (CI); homogeneity index (HI); dose-volume histograms (DVHs) of PTVs and OARs; NTCP, risk of radiation-induced cancer and dose accumulation during treatment. RESULTS IMRT and VMAT were superior to 3DCRT in terms of CI, HI and dose to the target volumes, as well as mandible and dose accumulation robustness. The techniques were equivalent in terms of dose and NTCP for the contralateral oral cavity, contralateral submandibular gland and mandible, when specific dose constraint objectives were used on the oral cavity volume. Although the volume of normal tissue exposed to low-dose radiation was significantly higher with IMRT and VMAT, the risk of radiation-induced secondary malignancy was dependant on the mathematical model used. CONCLUSION This study demonstrates the superiority of IMRT/VMAT techniques over 3DCRT in terms of dose homogeneity, conformity and consistent dose delivery to the PTV throughout the course of treatment in patients with lateralised oropharyngeal cancers. Dosimetry and NTCP calculations show that these techniques are equivalent to 3DCRT with regard to the risk of acute mucositis when specific dose constraint objectives were used on the contralateral oral cavity OAR.
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Affiliation(s)
- D McQuaid
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - A Dunlop
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - S Nill
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - C Franzese
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
| | - C M Nutting
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - K J Harrington
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - K L Newbold
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - S A Bhide
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK.
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK.
- The Institute of Cancer Research, SW3 6JB, London, UK.
- The Institute of Cancer Research, SM2 5NG, Sutton, UK.
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Bahrainy M, Kretschmer M, Jöst V, Kasch A, Würschmidt F, Dahle J, Lorenzen J. Treatment of breast cancer with simultaneous integrated boost in hybrid plan technique : Influence of flattening filter-free beams. Strahlenther Onkol 2016; 192:333-41. [PMID: 26972086 DOI: 10.1007/s00066-016-0960-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/10/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The present study compares in silico treatment plans using hybrid plan technique during hypofractionated radiation of mammary carcinoma with simultaneous integrated boost (SIB). The influence of 6 MV photon radiation in flattening filter free (FFF) mode against the clinical standard flattening filter (FF) mode is to be examined. PATIENTS AND METHODS RT planning took place with FF and FFF radiation plans for 10 left-sided breast cancer patients. Hybrid plans were realised with two tangential IMRT fields and one VMAT field. The dose prescription was in line with the guidelines in the ARO-2010-01 study. The dosimetric verification took place with a manufacturer-independent measurement system. RESULTS Required dose prescriptions for the planning target volumes (PTV) were achieved for both groups. The average dose values of the ipsi- and contralateral lung and the heart did not differ significantly. The overall average incidental dose to the left anterior descending artery (LAD) of 8.24 ± 3.9 Gy in the FFF group and 9.05 ± 3.7 Gy in the FF group (p < 0.05) were found. The dosimetric verifications corresponded to the clinical requirements. FFF-based RT plans reduced the average treatment time by 17 s/fraction. CONCLUSION In comparison to the FF-based hybrid plan technique the FFF mode allows further reduction of the average LAD dose for comparable target volume coverage without adverse low-dose exposure of contralateral structures. The combination of hybrid plan technique and 6 MV photon radiation in the FFF mode is suitable for use with hypofractionated dose schemes. The increased dose rate allows a substantial reduction of treatment time and thus beneficial application of the deep inspiration breath hold technique.
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Affiliation(s)
- Marzieh Bahrainy
- Radiologische Allianz, Mörkenstrasse 47, 22767, Hamburg, Germany.
| | | | - Vincent Jöst
- Radiologische Allianz, Mörkenstrasse 47, 22767, Hamburg, Germany
| | - Astrid Kasch
- Radiologische Allianz, Mörkenstrasse 47, 22767, Hamburg, Germany
| | | | - Jörg Dahle
- Radiologische Allianz, Mörkenstrasse 47, 22767, Hamburg, Germany
| | - Jörn Lorenzen
- Radiologische Allianz, Mörkenstrasse 47, 22767, Hamburg, Germany
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Farzin M, Molls M, Astner S, Rondak IC, Oechsner M. Simultaneous integrated vs. sequential boost in VMAT radiotherapy of high-grade gliomas. Strahlenther Onkol 2015; 191:945-52. [PMID: 26340939 DOI: 10.1007/s00066-015-0888-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 08/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 20 patients with high-grade gliomas, we compared two methods of planning for volumetric-modulated arc therapy (VMAT): simultaneous integrated boost (SIB) vs. sequential boost (SEB). The investigation focused on the analysis of dose distributions in the target volumes and the organs at risk (OARs). METHOD After contouring the target volumes [planning target volumes (PTVs) and boost volumes (BVs)] and OARs, SIB planning and SEB planning were performed. The SEB method consisted of two plans: in the first plan the PTV received 50 Gy in 25 fractions with a 2-Gy dose per fraction. In the second plan the BV received 10 Gy in 5 fractions with a dose per fraction of 2 Gy. The doses of both plans were summed up to show the total doses delivered. In the SIB method the PTV received 54 Gy in 30 fractions with a dose per fraction of 1.8 Gy, while the BV received 60 Gy in the same fraction number but with a dose per fraction of 2 Gy. RESULTS All of the OARs showed higher doses (Dmax and Dmean) in the SEB method when compared with the SIB technique. The differences between the two methods were statistically significant in almost all of the OARs. Analysing the total doses of the target volumes we found dose distributions with similar homogeneities and comparable total doses. CONCLUSION Our analysis shows that the SIB method offers advantages over the SEB method in terms of sparing OARs.
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Affiliation(s)
- Mostafa Farzin
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany. .,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran.
| | - Michael Molls
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Sabrina Astner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Ina-Christine Rondak
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany.
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Martin JM, Handorf EA, Price RA, Cherian G, Buyyounouski MK, Chen DY, Kutikov A, Johnson ME, Ma CMC, Horwitz EM. Comparison of testicular dose delivered by intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with prostate cancer. Med Dosim 2015; 40:186-9. [PMID: 25595491 DOI: 10.1016/j.meddos.2014.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 10/15/2014] [Accepted: 11/05/2014] [Indexed: 11/16/2022]
Abstract
A small decrease in testosterone level has been documented after prostate irradiation, possibly owing to the incidental dose to the testes. Testicular doses from prostate external beam radiation plans with either intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) were calculated to investigate any difference. Testicles were contoured for 16 patients being treated for localized prostate cancer. For each patient, 2 plans were created: 1 with IMRT and 1 with VMAT. No specific attempt was made to reduce testicular dose. Minimum, maximum, and mean doses to the testicles were recorded for each plan. Of the 16 patients, 4 received a total dose of 7800 cGy to the prostate alone, 7 received 8000 cGy to the prostate alone, and 5 received 8000 cGy to the prostate and pelvic lymph nodes. The mean (range) of testicular dose with an IMRT plan was 54.7 cGy (21.1 to 91.9) and 59.0 cGy (25.1 to 93.4) with a VMAT plan. In 12 cases, the mean VMAT dose was higher than the mean IMRT dose, with a mean difference of 4.3 cGy (p = 0.019). There was a small but statistically significant increase in mean testicular dose delivered by VMAT compared with IMRT. Despite this, it unlikely that there is a clinically meaningful difference in testicular doses from either modality.
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Affiliation(s)
- Jeffrey M Martin
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - George Cherian
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - David Y Chen
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Alexander Kutikov
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Matthew E Johnson
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
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Dai X, Zhao Y, Liang Z, Dassarath M, Wang L, Jin L, Chen L, Dong J, Price RA, Ma CM. Volumetric-modulated arc therapy for oropharyngeal carcinoma: a dosimetric and delivery efficiency comparison with static-field IMRT. Phys Med 2014; 31:54-9. [PMID: 25284321 DOI: 10.1016/j.ejmp.2014.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/04/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
Abstract
The purpose of this study is to evaluate the treatment plan adequacy and delivery efficiency among volumetric-modulated arc therapy (VMAT) with one or two arcs and the conventional static-field dynamic multileaf collimator (dMLC) intensity-modulated radiation therapy (IMRT) in patients undergoing oropharyngeal carcinoma. Fifteen patient cases were included in this investigation. Each of the cases was planned using step-and-shoot IMRT, VMAT with a single arc (Arc1) and VMAT with double arcs (Arc2). A two-dose level prescription for planning target volumes (PTVs) was delivered with 70 Gy/56 Gy in 30 fractions. Comparisons were performed of the dose-volume histograms (DVH) for PTVs, the DVH for organs at risk (OARs), the monitor units per fraction (MU/fx), and delivery time. IMRT and Arc2 achieved similar target coverage, but superior to Arc1. Apart from the oral cavity, Arc1 showed no advantage in sparing of OARs compared with IMRT, while Arc2 obtained equivalent or better sparing of OARs among the three techniques. VMAT reduced MU/fx and shortened delivery time remarkably compared with IMRT. Our results demonstrated that for oropharyngeal cases, Arc2 can achieve superior target coverage and normal tissue sparing, as well as a significant reduction in treatment time.
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Affiliation(s)
- Xiaofang Dai
- Cancer Center, Union Hospital, Huazhong University of Sciences and Technology, Wuhan, China
| | - Yingchao Zhao
- Cancer Center, Union Hospital, Huazhong University of Sciences and Technology, Wuhan, China
| | - Zhiwen Liang
- Cancer Center, Union Hospital, Huazhong University of Sciences and Technology, Wuhan, China
| | - Meera Dassarath
- Cancer Center, Union Hospital, Huazhong University of Sciences and Technology, Wuhan, China
| | - Lu Wang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Lihui Jin
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Lili Chen
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - James Dong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - C-M Ma
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Li G, Wu K, Peng G, Zhang Y, Bai S. A retrospective analysis for patient-specific quality assurance of volumetric-modulated arc therapy plans. Med Dosim 2014; 39:309-13. [PMID: 24958705 DOI: 10.1016/j.meddos.2014.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 04/23/2014] [Accepted: 05/06/2014] [Indexed: 02/05/2023]
Abstract
Volumetric-modulated arc therapy (VMAT) is now widely used clinically, as it is capable of delivering a highly conformal dose distribution in a short time interval. We retrospectively analyzed patient-specific quality assurance (QA) of VMAT and examined the relationships between the planning parameters and the QA results. A total of 118 clinical VMAT cases underwent pretreatment QA. All plans had 3-dimensional diode array measurements, and 69 also had ion chamber measurements. Dose distribution and isocenter point dose were evaluated by comparing the measurements and the treatment planning system (TPS) calculations. In addition, the relationship between QA results and several planning parameters, such as dose level, control points (CPs), monitor units (MUs), average field width, and average leaf travel, were also analyzed. For delivered dose distribution, a gamma analysis passing rate greater than 90% was obtained for all plans and greater than 95% for 100 of 118 plans with the 3%/3-mm criteria. The difference (mean ± standard deviation) between the point doses measured by the ion chamber and those calculated by TPS was 0.9% ± 2.0% for all plans. For all cancer sites, nasopharyngeal carcinoma and gastric cancer have the lowest and highest average passing rates, respectively. From multivariate linear regression analysis, the dose level (p = 0.001) and the average leaf travel (p < 0.001) showed negative correlations with the passing rate, and the average field width (p = 0.003) showed a positive correlation with the passing rate, all indicating a correlation between the passing rate and the plan complexity. No statistically significant correlation was found between MU or CP and the passing rate. Analysis of the results of dosimetric pretreatment measurements as a function of VMAT plan parameters can provide important information to guide the plan parameter setting and optimization in TPS.
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Affiliation(s)
- Guangjun Li
- Radiation Physics Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Kui Wu
- Department of Radiotherapy, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, P.R. China
| | - Guang Peng
- Radiation Physics Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yingjie Zhang
- Radiation Physics Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Sen Bai
- Radiation Physics Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
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Wang X, Li G, Zhang Y, Bai S, Xu F, Wei Y, Gong Y. Single-arc volumetric-modulated arc therapy (sVMAT) as adjuvant treatment for gastric cancer: dosimetric comparisons with three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). Med Dosim 2013; 38:395-400. [PMID: 23791504 DOI: 10.1016/j.meddos.2013.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 03/05/2013] [Accepted: 04/26/2013] [Indexed: 02/05/2023]
Abstract
To compare the dosimetric differences between the single-arc volumetric-modulated arc therapy (sVMAT), 3-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT) techniques in treatment planning for gastric cancer as adjuvant radiotherapy. Twelve patients were retrospectively analyzed. In each patient's case, the parameters were compared based on the dose-volume histogram (DVH) of the sVMAT, 3D-CRT, and IMRT plans, respectively. Three techniques showed similar target dose coverage. The maximum and mean doses of the target were significantly higher in the sVMAT plans than that in 3D-CRT plans and in the 3D-CRT/IMRT plans, respectively, but these differences were clinically acceptable. The IMRT and sVMAT plans successfully achieved better target dose conformity, reduced the V20/30, and mean dose of the left kidney, as well as the V20/30 of the liver, compared with the 3D-CRT plans. And the sVMAT technique reduced the V20 of the liver much significantly. Although the maximum dose of the spinal cord were much higher in the IMRT and sVMAT plans, respectively (mean 36.4 vs 39.5 and 40.6Gy), these data were still under the constraints. Not much difference was found in the analysis of the parameters of the right kidney, intestine, and heart. The IMRT and sVMAT plans achieved similar dose distribution to the target, but superior to the 3D-CRT plans, in adjuvant radiotherapy for gastric cancer. The sVMAT technique improved the dose sparings of the left kidney and liver, compared with the 3D-CRT technique, but showed few dosimetric advantages over the IMRT technique. Studies are warranted to evaluate the clinical benefits of the VMAT treatment for patients with gastric cancer after surgery in the future.
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Affiliation(s)
- Xin Wang
- Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
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Tsai YC, Tsai CL, Hsu FM, Jian-Kuen W, Chien-Jang W, Cheng JCH. Superior liver sparing by combined coplanar/noncoplanar volumetric-modulated arc therapy for hepatocellular carcinoma: a planning and feasibility study. Med Dosim 2013; 38:366-71. [PMID: 23769922 DOI: 10.1016/j.meddos.2013.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/18/2013] [Accepted: 04/04/2013] [Indexed: 11/19/2022]
Abstract
Compared with step-and-shoot intensity-modulated radiotherapy (sIMRT) and tomotherapy, volumetric-modulated arc therapy (VMAT) allows additional arc configurations in treatment planning and noncoplanar (NC) delivery. This study was first to compare VMAT planning with sIMRT planning, and the second to evaluate the toxicity of coplanar (C)/NC-VMAT treatment in patients with hepatocellular carcinoma (HCC). Fifteen patients with HCC (7 with left-lobe and 8 with right-lobe tumors) were planned with C-VMAT, C/NC-VMAT, and sIMRT. The median total dose was 49Gy (range: 40 to 56Gy), whereas the median fractional dose was 3.5Gy (range: 3 to 8Gy). Different doses/fractionations were converted to normalized doses of 2Gy per fraction using an α/β ratio of 2.5. The mean liver dose, volume fraction receiving more than 10Gy (V10), 20Gy (V20), 30Gy (V30), effective volume (Veff), and equivalent uniform dose (EUD) were compared. C/NC-VMAT in 6 patients was evaluated for delivery accuracy and treatment-related toxicity. Compared with sIMRT, both C-VMAT (p = 0.001) and C/NC-VMAT (p = 0.03) had significantly improved target conformity index. Compared with C-VMAT and sIMRT, C/NC-VMAT for treating left-lobe tumors provided significantly better liver sparing as evidenced by differences in mean liver dose (p = 0.03 and p = 0.007), V10 (p = 0.003 and p = 0.009), V20 (p = 0.006 and p = 0.01), V30 (p = 0.02 and p = 0.002), Veff (p = 0.006 and p = 0.001), and EUD (p = 0.04 and p = 0.003), respectively. For right-lobe tumors, there was no difference in liver sparing between C/NC-VMAT, C-VMAT, and sIMRT. In all patients, dose to more than 95% of target points met the 3%/3mm criteria. All 6 patients tolerated C/NC-VMAT and none of them had treatment-related ≥ grade 2 toxicity. The C/NC-VMAT can be used clinically for HCC and provides significantly better liver sparing in patients with left-lobe tumors.
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Affiliation(s)
- Yi-Chun Tsai
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
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