Total-body irradiation using linac-based volumetric modulated arc therapy: Its clinical accuracy, feasibility and reliability

Tas, B.; Durmuş, İsmail; Okumus, A.; Uzel, Ömer; Gökçe, Müge; Goksoy, Hasan Sami; Özşahin, Esat Mahmut

doi:10.1016/j.radonc.2018.08.005

Cited by 53 publications

(84 citation statements)

References 22 publications

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“…The sweeping beam technique needs the couch on the oor with the Makrolon plate on top. The inverseplanned IMRT based TBI technique was developed to improve upon these shortcomings, 15,16 a bene t could be demonstrated with regard to dose distribution and homogeneity and the selective dose-reduction to organs at risk. 17 Patients taller than 120 cm cannot be treated in one position due to the limited cranial-caudal couch shift capacities of the linac.…”

Section: Quality Assurancementioning

confidence: 99%

“…The main problem of this approach is additional use of the special rotatable tabletop at the linear accelerator, it is not available in most hospital around the world. 16 Bora Tas et al introduced total-body irradiation using linac-based volumetric modulated arc therapy, high-dose junction regions were eliminated after the registration of two CT sets via bias-dose properties of Monaco 5.11 TPS, Plan adaptation delivery while ensuring OAR tolerances never exceeded due to biasdose planning because TPS considers dose distribution from previous plans while optimizing the cumulative dose distribution, but when plans were recalculated with each 3.0-mm, 6.0-mm, 9.0-mm, and 12.0-mm longitudinal misalignments, an average of 2.0% ± 0.7, 3.7% ± 1.2, 6.5% ± 1.7 and 7.2% ± 1.7 higher mean lung doses; 2.6% ± 1. Dose distribution, ve dose-drop sections and ve isocenters.…”

Section: Quality Assurancementioning

confidence: 99%

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First Experience of Standard Linac, Rapid Arc and Dose-drop Scheme Based Total Body Irradiation

Xu¹,

Li²,

Hui³

et al. 2020

Preprint

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Background and purpose: To introduce a standard linac with true attachment free, rapid arc and dose-drop scheme for positioning related dose deviation control based total body irradiation(TBI).Materials/Methods: One eight years old girl diagnosed with acute lymphocytic leukemia underwent TBI in 2020. Target volumes and organs at risk were contoured after CT simulation. Total sixteen ARC and four AP-PA from five isocenters were designed. A dose-drop scheme on both sides of adjacent region were performed to reduce positioning-related dose deviation. A series of quality assurance before radiotherapy and real-time dose monitoring during radiotherapy were carried out.Results: The average on board imaging (OBI) time of per fraction was 40.3 min, the average beam on time of per fraction was 37.2 min, the average time to change from head first to feet first position was 18.4 min. The average mean lung dose was 9.89 Gy, the maximum lens dose was 7.60 Gy, the mean PTV_total dose was 12.17Gy, 98.23% PTV_total volume was covered by 90% of the prescription dose. The maximum dose (Dmax) of PTV_total was 13.65Gy. Dmean and V10.8 of PTV_total are only slightly different(0.49% - 1.89% and 0.26% - 1.04% respectively) even with an error of 5 - 20mm longitudinal misalignments. Gamma passing rate(3mm/ 3% Gamma criteria) are between 93.5% and 100%. Real-time dose monitoring showed an overall deviation of -3.9%±5.51%.Conclusions: Standard linac, rapid arc and dose-drop for positioning-related dose deviation control based total body irradiation is feasible, accurate, and reliable. It is worthy of clinical application.

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Section: Quality Assurancementioning

confidence: 99%

Section: Quality Assurancementioning

confidence: 99%

First Experience of Standard Linac, Rapid Arc and Dose-drop Scheme Based Total Body Irradiation

Xu¹,

Li²,

Hui³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Smooth junctions between segments were achieved using inverse planning, resulting in a homogeneous dose delivery. A similar technique was described by Tas et al, but only 3‐5 isocenters were required . They additionally completed three‐dimensional dose‐volume histogram (DVH) based quality assurance of their plans including their junction regions, thus presenting a robust and accurate method of TBI delivery.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, highly modulated plans increase the already prolonged beam‐on times for TBI treatments. Reported times including patient set‐up for one fraction VMAT TBI are between 55 and 120 min for adult patients . Multi‐fraction treatments lead to considerable clinic resource utilization as well as the patient spending long periods on the treatment couch resulting in heightened discomfort.…”

Section: Introductionmentioning

confidence: 99%

“…A similar technique was described by Tas et al, but only 3-5 isocenters were required. 7 They additionally completed three-dimensional dose-volume histogram (DVH) based quality assurance of their plans including their junction regions, thus presenting a robust and accurate method of TBI delivery. While VMAT TBI is resulting in higher quality plans, some problems persist.…”

Section: Introductionmentioning

confidence: 99%

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Standardized flattening filter free volumetric modulated arc therapy plans based on anteroposterior width for total body irradiation

Frederick

Hudson

Balogh

et al. 2020

J Applied Clin Med Phys

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In this work, the feasibility of using flattening filter free (FFF) beams in volumetric modulated arc therapy (VMAT) total body irradiation (TBI) treatment planning to decrease protracted beam‐on times for these treatments was investigated. In addition, a methodology was developed to generate standardized VMAT TBI treatment plans based on patient physical dimensions to eliminate plan optimization time. A planning study cohort of 47 TBI patients previously treated with optimized VMAT ARC 6 MV beams was retrospectively examined. These patients were sorted into six categories depending on height and anteroposterior (AP) width at the umbilicus. Using Varian Eclipse, clinical 40 cm × 10 cm open field arcs were substituted with 6 MV FFF. Mid‐plane lateral dose profiles in conjunction with relative arc output factors (RAOF) yielded how far a given multileaf collimator (MLC) leaf must move in order to achieve a mid‐plane 100% isodose for a specific control point. Linear interpolation gave the dynamic MLC aperture for the entire arc for each patient AP width category, which was subsequently applied through Python scripting. All FFF VMAT TBI plans were then evaluated by two radiation oncologists and deemed clinically acceptable. The FFF and clinical VMAT TBI plans had similar Body–5 mm D98% distributions, but overall the FFF plans had statistically significantly increased or broader Body–5 mm D2% and mean lung dose distributions. These differences are not considered clinically significant. Median beam‐on times for the FFF and clinical VMAT TBI plans were 11.07 and 18.06 min, respectively, and planning time for the FFF VMAT TBI plans was reduced by 34.1 min. In conclusion, use of FFF beams in VMAT TBI treatment planning resulted in dose homogeneity similar to our current VMAT TBI technique. Clinical dosimetric criteria were achieved for a majority of patients while planning and calculated beam‐on times were reduced, offering the possibility of improved patient experience.

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Automatic treatment planning for VMAT‐based total body irradiation using Eclipse scripting

Teruel¹,

Taneja²,

Galavis³

et al. 2021

J Applied Clin Med Phys

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The purpose of this work is to establish an automated approach for a multiple isocenter volumetric arc therapy (VMAT)-based TBI treatment planning approach. Five anonymized full-body CT imaging sets were used. A script was developed to automate and standardize the treatment planning process using the Varian Eclipse v15.6 Scripting API. The script generates two treatment plans: a headfirst VMAT-based plan for upper body coverage using four isocenters and a total of eight full arcs; and a feet-first AP/PA plan with three isocenters that covers the lower extremities of the patient. PTV was the entire body cropped 5 mm from the patient surface and extended 3 mm into the lungs and kidneys. Two plans were generated for each case: one to a total dose of 1200 cGy in 8 fractions and a second one to a total dose of 1320 cGy in 8 fractions. Plans were calculated using the AAA algorithm and 6 MV photon energy. One plan was created and delivered to an anthropomorphic phantom containing 12 OSLDs for in-vivo dose verification. For the plans prescribed to 1200 cGy total dose the following dosimetric results were achieved: median PTV V100% = 94.5%; median PTV D98% = 89.9%; median lungs Dmean = 763 cGy; median left kidney Dmean = 1058 cGy; and median right kidney Dmean = 1051 cGy. For the plans prescribed to 1320 cGy total dose the following dosimetric results were achieved: median PTV V100% = 95.0%; median PTV D98% = 88.7%; median lungs Dmean = 798 cGy; median left kidney Dmean = 1059 cGy; and median right kidney Dmean = 1064 cGy. Maximum dose objective was met for all cases. The dose deviation between the treatment planning dose and the dose measured by the OSLDs was within AE4%. In summary, we have demonstrated that scripting can produce high-quality plans based on predefined dose objectives and can decrease planning time by automatic target and optimization contours generation, plan creation, field and isocenter placement, and optimization objectives setup.

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Total-body irradiation using linac-based volumetric modulated arc therapy: Its clinical accuracy, feasibility and reliability

Cited by 53 publications

References 22 publications

First Experience of Standard Linac, Rapid Arc and Dose-drop Scheme Based Total Body Irradiation

First Experience of Standard Linac, Rapid Arc and Dose-drop Scheme Based Total Body Irradiation

Standardized flattening filter free volumetric modulated arc therapy plans based on anteroposterior width for total body irradiation

Automatic treatment planning for VMAT‐based total body irradiation using Eclipse scripting

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