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Wilke L, Moustakis C, Blanck O, Albers D, Albrecht C, Avcu Y, Boucenna R, Buchauer K, Etzelstorfer T, Henkenberens C, Jeller D, Jurianz K, Kornhuber C, Kretschmer M, Lotze S, Meier K, Pemler P, Riegler A, Röser A, Schmidhalter D, Spruijt KH, Surber G, Vallet V, Wiehle R, Willner J, Winkler P, Wittig A, Guckenberger M, Tanadini-Lang S. Improving interinstitutional and intertechnology consistency of pulmonary SBRT by dose prescription to the mean internal target volume dose. Strahlenther Onkol 2021; 197:836-846. [PMID: 34196725 PMCID: PMC8397670 DOI: 10.1007/s00066-021-01799-w] [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: 05/13/2020] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
Purpose Dose, fractionation, normalization and the dose profile inside the target volume vary substantially in pulmonary stereotactic body radiotherapy (SBRT) between different institutions and SBRT technologies. Published planning studies have shown large variations of the mean dose in planning target volume (PTV) and gross tumor volume (GTV) or internal target volume (ITV) when dose prescription is performed to the PTV covering isodose. This planning study investigated whether dose prescription to the mean dose of the ITV improves consistency in pulmonary SBRT dose distributions. Materials and methods This was a multi-institutional planning study by the German Society of Radiation Oncology (DEGRO) working group Radiosurgery and Stereotactic Radiotherapy. CT images and structures of ITV, PTV and all relevant organs at risk (OAR) for two patients with early stage non-small cell lung cancer (NSCLC) were distributed to all participating institutions. Each institute created a treatment plan with the technique commonly used in the institute for lung SBRT. The specified dose fractionation was 3 × 21.5 Gy normalized to the mean ITV dose. Additional dose objectives for target volumes and OAR were provided. Results In all, 52 plans from 25 institutions were included in this analysis: 8 robotic radiosurgery (RRS), 34 intensity-modulated (MOD), and 10 3D-conformal (3D) radiation therapy plans. The distribution of the mean dose in the PTV did not differ significantly between the two patients (median 56.9 Gy vs 56.6 Gy). There was only a small difference between the techniques, with RRS having the lowest mean PTV dose with a median of 55.9 Gy followed by MOD plans with 56.7 Gy and 3D plans with 57.4 Gy having the highest. For the different organs at risk no significant difference between the techniques could be found. Conclusions This planning study pointed out that multiparameter dose prescription including normalization on the mean ITV dose in combination with detailed objectives for the PTV and ITV achieve consistent dose distributions for peripheral lung tumors in combination with an ITV concept between different delivery techniques and across institutions. Supplementary Information The online version of this article (10.1007/s00066-021-01799-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Wilke
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich, Switzerland.
| | - C Moustakis
- Klinik für Strahlentherapie, Universitätsklinikum Münster, Münster, Germany
| | - O Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - D Albers
- Klinik für Strahlentherapie und Radioonkologie, Universtitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - C Albrecht
- CyberKnife Centrum Süd, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Y Avcu
- Klinik für Strahlentherapie und Radioonkologie, Universitätsspital Basel, Basel, Switzerland
| | - R Boucenna
- Institut de radio-oncologie, Hislanden Lausanne, Lausanne, Switzerland
| | - K Buchauer
- Klinik für Radio-Onkologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - T Etzelstorfer
- Radio-Onkologie, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - C Henkenberens
- Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - D Jeller
- Radio-Onkologie, Kantonsspital Luzern, Luzern, Switzerland
| | - K Jurianz
- MVZ Gamma-Knife Zentrum Krefeld, Krefeld, Germany
| | - C Kornhuber
- Klinik für Strahlentherapie, Universitätsklinikum Halle, Halle, Germany
| | | | - S Lotze
- Klinik für Radioonkologie und Strahlentherapie, Uniklinik RWTH Aachen, Aachen, Germany
| | - K Meier
- Strahlentherapie, Klinikum Wolfsburg, Wolfsburg, Germany
| | - P Pemler
- Klinik für Radioonkologie, Stadtspital Triemli, Zürich, Switzerland
| | - A Riegler
- Institut für Radioonkologie und Strahlentherapie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - A Röser
- Strahlentherapie und Radio-Onkologie, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - D Schmidhalter
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern, Switzerland.,University Hospital, and University of Bern, Bern, Switzerland
| | - K H Spruijt
- Institut de radio-oncologie, Clinique des Grangettes, Geneva, Switzerland
| | - G Surber
- Institut für Radiochirurgie und Präzisionsbestrahlung, CyberKnife Centrum Mitteldeutschland, Erfurt, Germany
| | - V Vallet
- Service de radio-oncologie, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - R Wiehle
- Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - J Willner
- Klinik für Strahlentherapie, Klinikum Bayreuth, Bayreuth, Germany
| | - P Winkler
- Universitätsklinik für Strahlentherapie-Radioonkologie, LKH-Univ. Klinikum Graz, Graz, Austria
| | - A Wittig
- Departent of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - M Guckenberger
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich, Switzerland
| | - S Tanadini-Lang
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich, Switzerland
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Wilke L, Blanck O, Albrecht C, Avcu Y, Boucenna R, Buchauer K, Etzelstorfer T, Henkenberens C, Jellner D, Jurianz K, Kornhuber C, Lotze S, Meier K, Pemler P, Riegler A, Röser A, Schmidhalter D, Spruijt K, Surber G, Vallet V, Wiehle R, Willner J, Winkler P, Wittig A, Moustakis C. OC-0416: Can a consistent dose to the target volume in SBRT be obtained by prescribing on the mean ITV dose? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30726-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schneider U, Besserer J, Erckes C, Pemler P, Reponen J. CT based lung density correction verification with in vivo dosimetry using diodes. Z Med Phys 2002; 11:257-60. [PMID: 11820182 DOI: 10.1016/s0939-3889(15)70525-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In vivo dose measurements with diodes are easy to perform. The first aim of our study was to show whether diode measurements of the patient exit doses are precise enough for verifying inhomogeneity corrections used for treatment planning. The second aim was to assess the precision of the modified Batho Law inhomogeneity correction of the CadPlan treatment planning system. For this purpose, entrance and lait doses were measured in the thoracic region of 115 patients. Diode measurements were sufficiently precise to verify the density corrections predicted by the treatment planning system (< 0.5% of ICRU dose). The measured doses were compared with calculations of the CadPlan treatment planning system. The mean deviation of the exit dose calculations within the measurements error was zero. The present results show that measurements of exit dose even in a small number of patients are sufficient to identify systematic errors in the dose calculation.
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Affiliation(s)
- U Schneider
- Medizinische Physik, Klinik für Radio-Onkologie und Nuklearmedizin, Stadtspital Triemli, Zürich
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Pemler P, Besserer J, Lombriser N, Pescia R, Schneider U. Influence of respiration-induced organ motion on dose distributions in treatments using enhanced dynamic wedges. Med Phys 2001; 28:2234-40. [PMID: 11764027 DOI: 10.1118/1.1410121] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The mean velocity of respiration-induced organ motion in cranio-caudal direction is of the same magnitude as the velocity of the moving jaw during a treatment with an enhanced dynamic wedge. Therefore, if organ motion is present during collimator movement, the resulting dose distribution in wedge direction may differ from that obtained for the static case, i.e., without organ motion. The position as a function of time of the moving jaw has been derived from a log-file generated during each treatment. Parameters for the respiratory cycle and information about respiration-induced motion for organs in the upper abdomen were taken from the literature. Both movements were superimposed and the resulting monitor unit distribution has been calculated in the intrinsic coordinate system of the organ. The deviations from the static case have been studied as a function of wedge angle, amplitude of organ motion, respiratory rate, asymmetry of the respiratory cycle, beam energy, and the dose rate. If an amplitude of 30 mm and a respiratory rate of 10 min(-1) are assumed, the maximum deviation in monitor units is 2.5% for a 10 degees wedge, 7% for a 30 degrees wedge, and 16% for a 60 degrees wedge. Furthermore, a dose distribution for an organ undergoing respiration-induced motion has been generated and we found dose deviations of the same magnitude as calculated with the monitor unit distribution.
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Affiliation(s)
- P Pemler
- Department of Radiation Oncology and Nuclear Medicine, City Hospital, Zürich, Switzerland.
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Abstract
Experimental data from the literature on small-angle multiple Coulomb scattering of protons in various materials were analysed in order to device an equation for the scattering angle in the Gaussian approximation. In comparison to Highland's well-known formula, the present approximation can be integrated to take into account energy loss in the scattering media. In addition, it is more precise than Highland's formulation for thin and thick scatterers consisting of elements with low atomic number. The simple equation obtained in this study can be used to obtain prompt answers for scattering problems which can occur, for example, in proton therapy or proton radiography.
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Affiliation(s)
- U Schneider
- Klinik für Radio-Onkologie und Nuklearmedizin, Stadtspital Triemli, Zürich
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