Clinical Evaluation of an Immbolization System for Stereotactic Body Radiotherapy Using Helical Tomotherapy

Gutiérrez, Alonso N.; Stathakis, Sotirios; Crownover, Richard L.; Esquivel, Carlos O.; Shi, Chengyu; Papanikolaou, Nikos

doi:10.1016/j.meddos.2010.02.003

Cited by 12 publications

(14 citation statements)

References 13 publications

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“…The risk of a geographical miss or positioning error for hypo‐fractionated techniques can be greater than with conventional fractionation 1, 7, 8, 9, 10, 11, 12, 13. There are a number of immobilisation devices available, with most research being for SBRT, however, even for this indication unknowns remain.…”

Section: Introductionmentioning

confidence: 99%

A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

et al. 2016

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IntroductionPatient immobilisation is critically important for both highly conformal conventionally fractionated radiotherapy and for stereotactic body radiotherapy. Different immobilisation devices are available to maintain patient position for radiotherapy but the most suitable one remains unknown.MethodsForty‐five patients were randomly allocated to one of three immobilisation devices; the Q fix arm shuttle, BodyFIX without wrap or BodyFIX with wrap. Patients were imaged before and after treatment to ascertain intra‐fraction and inter‐fraction motion. Bony anatomy was used for matching to determine the positional accuracy of each device. Treatments were timed using a standard method. Patient comfort and staff satisfaction questionnaires were also issued to determine comfort, ease of use and preferences for each device.ResultsThe BodyFIX without wrap was the more accurate device; however, the differences between the devices were not statistically significant. The BodyFIX with wrap was found to take significantly longer to set up and set down compared to the arm shuttle and the BodyFIX without wrap (all P < 0.001). Patients (37%) marginally preferred the BodyFIX with wrap. Most (81%) staff preferred the BodyFIX without wrap.ConclusionImmobilisation using the BodyFIX without wrap was deemed to be suitable for clinical use. It was a clinically accurate device, the more efficient in terms of set up and set down time, the most preferred by staff and was accepted by patients.

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Section: Introductionmentioning

confidence: 99%

A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

et al. 2016

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“…At the current time, this remains a problem for HT-based SABR mainly because of its associated increase in intrafractional motion, which can be critical when treating central lesions with SABR. As a result, proper respiratory motion management and careful body immobilization are essential [32], [33]. In our experience, 4D CT simulation to account for tumor motion in various locations remains the most straight forward approach for respiratory motion management for HT clinically.…”

Section: Discussionmentioning

confidence: 99%

Critical Structure Sparing in Stereotactic Ablative Radiotherapy for Central Lung Lesions: Helical Tomotherapy vs. Volumetric Modulated Arc Therapy

Chi

et al. 2013

PLoS ONE

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BackgroundHelical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) are both advanced techniques of delivering intensity-modulated radiotherapy (IMRT). Here, we conduct a study to compare HT and partial-arc VMAT in their ability to spare organs at risk (OARs) when stereotactic ablative radiotherapy (SABR) is delivered to treat centrally located early stage non-small-cell lung cancer or lung metastases.Methods12 patients with centrally located lung lesions were randomly chosen. HT, 2 & 8 arc (Smart Arc, Pinnacle v9.0) plans were generated to deliver 70 Gy in 10 fractions to the planning target volume (PTV). Target and OAR dose parameters were compared. Each technique’s ability to meet dose constraints was further investigated.ResultsHT and VMAT plans generated essentially equivalent PTV coverage and dose conformality indices, while a trend for improved dose homogeneity by increasing from 2 to 8 arcs was observed with VMAT. Increasing the number of arcs with VMAT also led to some improvement in OAR sparing. After normalizing to OAR dose constraints, HT was found to be superior to 2 or 8-arc VMAT for optimal OAR sparing (meeting all the dose constraints) (p = 0.0004). All dose constraints were met in HT plans. Increasing from 2 to 8 arcs could not help achieve optimal OAR sparing for 4 patients. 2/4 of them had 3 immediately adjacent structures.ConclusionHT appears to be superior to VMAT in OAR sparing mainly in cases which require conformal dose avoidance of multiple immediately adjacent OARs. For such cases, increasing the number of arcs in VMAT cannot significantly improve OAR sparing.

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“…HT has been previously demonstrated to be adequate for treating moving targets with a hypofractionated course of radiotherapy [28]. Tumor motion can be addressed with four-dimensional (4D) CT to account for internal tumor motion throughout the entire respiratory cycle; while set up errors can be further reduced with HT compatible immobilization devices [29]. 4-D CT has been adopted in our institution since 2009.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Selection for Helical Tomotherapy Based Stereotactic Ablative Radiotherapy for Early-Stage Non-Small Cell Lung Cancer or Lung Metastases

et al. 2012

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BackgroundNo selection criteria for helical tomotherapy (HT) based stereotactic ablative radiotherapy (SABR) to treat early stage non-small cell lung cancer (NSCLC) or solitary lung metastases has been established. In this study, we investigate the dosimetric selection criteria for HT based SABR delivering 70 Gy in 10 fractions to avoid severe toxicity in the treatment of centrally located lesions when adequate target dose coverage is desired.Materials and Methods78 HT-SABR plans for solitary lung lesions were created to prescribe 70 Gy in 10 fractions to the planning target volume (PTV). The PTV was set to have ≥95% PTV receiving 70 Gy in each case. The cases for which dose constraints for ≥1 OAR could not be met without compromising the target dose coverage were compared with cases for which all target and OAR dose constraints were met.ResultsThere were 23 central lesions for which OAR dose constraints could not be met without compromising PTV dose coverage. Comparing to cases for which optimal HT-based SABR plans were generated, they were associated with larger tumor size (5.72±1.96 cm vs. 3.74±1.49 cm, p<0.0001), higher lung dose, increased number of immediately adjacent OARs ( 3.45±1.34 vs. 1.66±0.81, p<0.0001), and shorter distance to the closest OARs (GTV: 0.26±0.22 cm vs. 0.88±0.54 cm, p<0.0001; PTV 0.19±0.18 cm vs. 0.48±0.36 cm, p = 0.0001).ConclusionDelivery of 70 Gy in 10 fractions with HT to meet all the given OAR and PTV dose constraints are most likely when the following parameters are met: lung lesions ≤3.78 cm (11.98 cc), ≤2 immediately adjacent OARs which are ≥0.45 cm from the gross lesion and ≥0.21 cm from the PTV.

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Clinical Evaluation of an Immbolization System for Stereotactic Body Radiotherapy Using Helical Tomotherapy

Cited by 12 publications

References 13 publications

A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

Critical Structure Sparing in Stereotactic Ablative Radiotherapy for Central Lung Lesions: Helical Tomotherapy vs. Volumetric Modulated Arc Therapy

Dosimetric Selection for Helical Tomotherapy Based Stereotactic Ablative Radiotherapy for Early-Stage Non-Small Cell Lung Cancer or Lung Metastases

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