Comprehensive dosimetric planning comparison for early‐stage, non‐small cell lung cancer with SABR: fixed‐beam IMRT versus VMAT versus TomoTherapy

Xhaferllari, Ilma; El‐Sherif, Omar; Gaede, Stewart

doi:10.1120/jacmp.v17i5.6291

Cited by 18 publications

(22 citation statements)

References 29 publications

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“…SABR is an effective treatment for patients with severe complications or pulmonary function who are unable to tolerate surgery. Using 4D‐CT and daily CT simulation to confirm the position and reduce deviation, SABR can deliver a high biological effective dose (BED) to the target while minimizing toxicity to the surrounding normal tissue, which may translate into improved LC and survival rate . With the progress of radiotherapy technology, SABR can be used to treat central lung cancer and even ultracentral lung cancer, which used to be risky to treat.…”

Section: Discussionmentioning

confidence: 99%

“…Using 4D-CT and daily CT simulation to confirm the position and reduce deviation, SABR can deliver a high biological effective dose (BED) to the target while minimizing toxicity to the surrounding normal tissue, which may translate into improved LC and survival rate. 10,16,17 With the progress of radiotherapy technology, • ≥Grade 2 radiation pneumonitis: 13.4%, 5.5%…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic ablative radiotherapy of 60 Gy in eight fractions is safe for ultracentral non‐small cell lung cancer

et al. 2020

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Background There is no consensus on the definition or recommended radiotherapy treatment of ultracentral non‐small cell lung cancer (NSCLC). Here, we report our institution's experience in treating ultracentral lung cancer patients with stereotactic ablative radiotherapy (SABR) of 60 Gy in eight fractions. Methods We retrospectively reviewed the outcomes of 21 ultracentral NSCLC patients treated with 60 Gy SABR in eight fractions. We defined ultracentral lung cancer as the planning target volume (PTV) directly abutting or overlapping central structures, including the proximal bronchial tree, heart, and great vessels but not the esophagus. The Kaplan‐Meier method was used to estimate overall survival (OS), progression‐free survival (PFS) and local control (LC). Toxicity was scored per the CTCAE v4.03. Results The median follow‐up time was 15 months, and the median OS was 15 months. The one‐ and two‐year OS rates were 87.5% and 76.6%, respectively. The one‐ and two‐year PFS rates were 71.1% and 64.0%, respectively. The one‐ and two‐year LC rates were 92.9% and 92.9%, respectively. The rate of grade 2 treatment‐related toxicities was 19.1%. There was no grade ≥ 3 treatment‐related toxicity. Conclusion SABR of 60 Gy in eight fractions is feasible for ultracentral NSCLC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stereotactic ablative radiotherapy of 60 Gy in eight fractions is safe for ultracentral non‐small cell lung cancer

et al. 2020

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“…The study by Xhaferllari et al . 27 provided an extensive dosimetric planning among fixed-beam IMRT, VMAT, and TOMO for early-stage NSCLC with SABR. The results demonstrated that VMAT had the optimal trade-off in dose conformity, sparing normal tissue, and treatment efficiency when compared with fixed-beam.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric comparison of the helical tomotherapy, volumetric-modulated arc therapy and fixed-field intensity-modulated radiotherapy for stage IIB-IIIB non-small cell lung cancer

Deng

Yang

et al. 2017

Sci Rep

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The study aimed to compare the dosimetric parameters to target dose coverage and the critical structures in the treatment planning of helical tomotherapy (TOMO), volumetric-modulated arc therapy (VMAT), and fixed-field intensity-modulated radiotherapy (IMRT) for NSCLC delivering conventionally fractionated radiotherapy. Thirty patients with pathologically confirmed NSCLC were included. Three radiation treatment plans were designed for each patient. All patients received the uniform prescription dose of 60 Gy to the planning target volume. The conformity index (CI), heterogeneity index (HI), and parameters of critical structures were calculated. A significantly superior mean CI was observed in VMAT than in TOMO or IMRT (P = 0.013, 0.001). Mean HI was also better using VAMT or IMRT than TOMO (P = 0.002, 0.003). Mean lung V20 and V30 were significantly reduced by TOMO compared to IMRT (P = 0.019, 0.029). The heart was spared by IMRT compared to TOMO in terms of mean heart dose, V5, V10, and V20 (P < 0.05). In larger tumor, VMAT provided the optimal dose distribution and sparing to heart. Compared to TOMO and IMRT, VMAT achieved better target dose distribution and similar sparing of critical structures. VMAT seemed to be the optimal technique for NSCLC.

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“…According to the study conducted by Xhaferllari et. al [23], VMAT is dosimetrically advantageous in treating early-stage NSCLC with SABR compared to fixed-beam IMRT, while providing significantly shorter treatment times. Moreover, they pointed out that no significant difference was observed in the two VMAT techniques (SmartArc (SA) and RapidArc (RA)).…”

Section: Plan Comparisonmentioning

confidence: 99%

“…No studies dig into the SIB and conventional prescription VMAT plans. As it is widely known that VMAT is superior to IMRT in dosimetric aspect [23], our study focus on this two type prescription in VMAT plans. SIB-VMAT plans Zhang et al [24], the heart dose-volume parameters of V 5 and V 30 were independent predictors for both cardiac events and overall survival among patients with NSCLC.…”

Section: Plan Comparisonmentioning

confidence: 99%

Organ at risks sparing with simultaneous integrated boost volumetric modulated arc therapy for locally advanced non-small lung cancer: an automated treatment planning study

Wang

Chen

Zhang

et al. 2020

Preprint

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Background : The technique of simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT) have been widely used in locally advanced non-small cell lung cancer, however, its dosimetric advantages are seldom reported. This study aimed to investigate the dosimetric benefit of SIB-VMAT compared to conventional VMAT plans (C-VMAT). Methods : Forty patients with stage III non-small cell lung cancer in our hospital were randomly selected for the two type prescriptions. SIB-VMAT and C-VMAT plans were generated for each patient with the same optimization parameter by the automatic treatment planning system (TPS). The prescribed dose was 50.4 Gy in 28 fractions to PTV and 59.92 Gy in 28 fractions to PGTV in SIB-VMAT plans, with 60 Gy in 30 fractions to PTV in C-VMAT plans. Dose-volume metrics for the planning target volume, lung, heart, esophagus and spinal cord were recorded. The quality score (S D ) was used to evaluate organ at risks (OARs) protection for two type prescription plans. Results : Conformal coverage of the PGTV/PTV by the 95% of the prescription dose was well achieved in automated plans. SIB-VMAT plans achieved significantly lower S D values than C-VMAT plans (Mean: 0.064±0.106 vs. 0.145±0.181, P=0.001). Obvious reductions in mean dose, V 30 , V 40 and V 50 of total lung were observed in SIB-VMAT plans compared to C-VMAT plans, with median decreased proportions of 6.5%、8.7%、19.6% and 32.1%. Statistically significant decrease in heart V 30 and V 40 were also achieved in SIB-VMAT plans, with median decreased proportions of 26.1% and 38.8%. SIB-VMAT plans achieved significant reductions in the maximum doses to both esophagus and spinal cord. Conclusions : SIB-VMAT technique could lead to a substantial sparing of normal organs, including lung, heart, esophagus and cord, mainly through reducing high and inter-median dose exposure.

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Comprehensive dosimetric planning comparison for early‐stage, non‐small cell lung cancer with SABR: fixed‐beam IMRT versus VMAT versus TomoTherapy

Cited by 18 publications

References 29 publications

Stereotactic ablative radiotherapy of 60 Gy in eight fractions is safe for ultracentral non‐small cell lung cancer

Stereotactic ablative radiotherapy of 60 Gy in eight fractions is safe for ultracentral non‐small cell lung cancer

Dosimetric comparison of the helical tomotherapy, volumetric-modulated arc therapy and fixed-field intensity-modulated radiotherapy for stage IIB-IIIB non-small cell lung cancer

Organ at risks sparing with simultaneous integrated boost volumetric modulated arc therapy for locally advanced non-small lung cancer: an automated treatment planning study

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