Adaptive volumetric modulated arc treatment planning for esophageal cancers using cone beam computed tomography

Pothapregada, Sriram; Syamkumar, S.A.; Kumar, J.; Sukumar, Prabakar; Rajasekaran, Dhanabalan; Nagarajan, Vivekanandan

doi:10.1016/j.ejmp.2011.10.006

Cited by 16 publications

(14 citation statements)

References 11 publications

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“…Due to morphological variations caused by weight loss, intra/ interplay and organ motion, some OARs may be located in hot spot areas, compared to the planning prescription [2,7,10]. This could generate side effects, not detectable by clinical exams (i.e.…”

Section: Treatment Planning Systemmentioning

confidence: 96%

A support vector machine tool for adaptive tomotherapy treatments: Prediction of head and neck patients criticalities

et al. 2015

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Section: Treatment Planning Systemmentioning

confidence: 96%

A support vector machine tool for adaptive tomotherapy treatments: Prediction of head and neck patients criticalities

et al. 2015

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“…VMAT also represents an extension of IMRT which facilitates synchronized variations in gantry speed, dose rate, and the shape of the MLC and jaws [14,15]. Consequently, VMAT can achieve similar, if not better, dose distribution compared with IMRT with shorter treatment times and fewer monitor units (MUs) [15-19]. The application of VMAT to EC RT has obtained similar results, although a more extensive low dose region is involved which can affect normal tissue [9-13].…”

Section: Introductionmentioning

confidence: 99%

Reduced lung dose during radiotherapy for thoracic esophageal carcinoma: VMAT combined with active breathing control for moderate DIBH

et al. 2013

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BackgroundLung radiation injury is a critical complication of radiotherapy (RT) for thoracic esophageal carcinoma (EC). Therefore, the goal of this study was to investigate the feasibility and dosimetric effects of reducing the lung tissue irradiation dose during RT for thoracic EC by applying volumetric modulated arc radiotherapy (VMAT) combined with active breathing control (ABC) for moderate deep inspiration breath-hold (mDIBH).MethodsFifteen patients with thoracic EC were randomly selected to undergo two series of computed tomography (CT) simulation scans with ABC used to achieve mDIBH (representing 80% of peak DIBH value) versus free breathing (FB). Gross tumor volumes were contoured on different CT images, and planning target volumes (PTVs) were obtained using different margins. For PTV-FB, intensity-modulated radiotherapy (IMRT) was designed with seven fields, and VMAT included two whole arcs. For PTV-DIBH, VMAT with three 135° arcs was applied, and the corresponding plans were named: IMRT-FB, VMAT-FB, and VMAT-DIBH, respectively. Dosimetric differences between the different plans were compared.ResultsThe heart volumes decreased by 19.85%, while total lung volume increased by 52.54% in mDIBH, compared to FB (p < 0.05). The mean conformality index values and homogeneity index values for VMAT-DIBH (0.86, 1.07) were slightly worse than those for IMRT-FB (0.90, 1.05) and VMAT-FB (0.90, 1.06) (p > 0.05). Furthermore, compared to IMRT-FB and VMAT-FB, VMAT-DIBH reduced the mean total lung dose by 18.64% and 17.84%, respectively (p < 0.05); moreover, the V5, V10, V20, and V30 values for IMRT-FB and VMAT-FB were reduced by 10.84% and 10.65% (p > 0.05), 12.5% and 20% (p < 0.05), 30.77% and 33.33% (p < 0.05), and 50.33% and 49.15% (p < 0.05), respectively. However, the heart dose-volume indices were similar between VMAT-DIBH and VMAT-FB which were lower than IMRT-FB without being statistically significant (p > 0.05). The monitor units and treatment time of VMAT-DIBH were also the lowest (p < 0.05).ConclusionsVMAT combined with ABC to achieve mDIBH is a feasible approach for RT of thoracic EC. Furthermore, this method has the potential to effectively reduce lung dose in a shorter treatment time and with better targeting accuracy.

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“…[15] Adaptive plans revealed significantly reduced V10Gy, V20Gy, and mean lung dose values as well as smaller D35% and mean heart doses compared with the initial plans. [15] In another study from Denmark, 29 patients with esophageal cancer were evaluated with daily CBCT and an additional CT at medial fraction 10 (range, [9][10][11][12][13][14]. [16] After the contouring and re-planning processes, two CTs were compared whether there was a decrease <1% in CTV or < 3% in PTV coverage that was accepted.…”

Section: Discussionmentioning

confidence: 99%

Case Presentation: The Effect of Volumetric Image Guidance & Adaptive Radiotherapy on Cardiac Dose in A Patient with Esophageal Cancer

Sezen¹

2018

TJ Oncol

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SUMMARYWe present the case of a patient with esophageal cancer whose tumor size regression prompted re-planning to decrease the cardiac dose. A 68-year-old male presented at our outpatient clinic with dysphagia. He was diagnosed with clinical T3N1M0 adenocarcinoma located at the distal esophagus-esophagogastric junction. He was decided to have surgery after receiving neoadjuvant chemoradiotherapy. Following 4-D CT simulation, IG-IMRT with SIB technique was planned as 50 Gy in 25 fractions to iGTV and as 45 Gy to the area identified as the CTV. Daily kV and weekly CBCT were planned at the beginning of the treatment. Concurrent CT with weekly paclitaxel-carboplatin was administered. At the simulation and start of the treatment, the heart was pushed anteriorly due to the mass effect and dilatation in the mid-lower esophagus. The mass and dilatation regressed at the weekly CBCT of the patient. The thirdweek CBCT evaluation revealed the movement of the heart posteriorly into the PTV. Re-simulation was performed to continue with the adaptive planning for the last 10 treatment fractions. The cumulative dose received by the heart was reduced from 96% to 93% for V5Gy, from 79% to 60.8% for V10Gy, from 60% to 43.2% for V15Gy, from 35% to 21% for V20Gy, and from 29.6 to 28 Gy for the mean cardiac dose with the volumetric image-guided adaptive planning. If tumor regression is predicted during radiotherapy to possibly change doses of organs at risk, volumetric image guidance should be encouraged once per week, at least, to consider adaptive treatment when required to ensure the critical organ doses within safe limits.

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Adaptive volumetric modulated arc treatment planning for esophageal cancers using cone beam computed tomography

Cited by 16 publications

References 11 publications

A support vector machine tool for adaptive tomotherapy treatments: Prediction of head and neck patients criticalities

A support vector machine tool for adaptive tomotherapy treatments: Prediction of head and neck patients criticalities

Reduced lung dose during radiotherapy for thoracic esophageal carcinoma: VMAT combined with active breathing control for moderate DIBH

Case Presentation: The Effect of Volumetric Image Guidance & Adaptive Radiotherapy on Cardiac Dose in A Patient with Esophageal Cancer

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