Conkiss: Conformal Kidneys Sparing 3D Noncoplanar Radiotherapy Treatment for Pancreatic Cancer As an Alternative to IMRT

Sebestyén, Zsolt; Kovács, Péter; Gulybán, Ákos; Farkas, Róbert; Bellyei, Szabolcs; Liposits, Gábor; Szigeti, András; Ésik, Olga; Dérczy, Katalin; Mangel, László

doi:10.1016/j.meddos.2009.11.001

Cited by 2 publications

(1 citation statement)

References 23 publications

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“…Treatment planning was performed on the CT acquired at 0% of expiration, where the MIFE component was asymmetrically applied to the CTV to obtain the PTV. A five‐beam arrangement was applied, as described in the 3D conformal CONKISS method (14) . This method uses one anterior–posterior‐like beam with 40° gantry (G40) and 90° table angle (T90) and four lateral fields, G270–T340, G90–T340, G270–T20, and G90–T20.…”

Section: Methodsmentioning

confidence: 99%

Free‐breathing conformal irradiation of pancreatic cancer

Solla

Zucca

Possanzini

et al. 2013

J Applied Clin Med Phys

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The purpose of this study was to assess treatment margins in free‐breathing irradiation of pancreatic cancer after bone alignment, and evaluate their impact on conformal radiotherapy. Fifteen patients with adenocarcinoma of the head of the pancreas underwent implantation of single fiducial marker. Intrafraction uncertainties were assessed on simulation four‐dimensional computed tomography (4D CT) by calculating maximal intrafraction fiducial excursion (MIFE). In the first ten patients, after bony alignment, the position of the fiducial was identified on weekly acquired megavolt cone‐beam CT (MV‐CBCT). The interfraction residual uncertainties were estimated by measuring the fiducial displacements with respect to the position in the first session. Patient mean (pM) and patient standard deviation (pSD) of fiducial displacement, mean (μnormalM) and standard deviation (μSD) of pM, and root‐mean‐square of pSD (σres) were calculated. In the other five patients, MIFE was added to the residual component to obtain personalized margin. In these patients, conformal kidney sparing (CONKISS) irradiation was planned prescribing 54/45 Gy to PTV1/PTV2. The organ‐at‐risk limits were set according to current NCCN recommendation. No morbidity related to the fiducial marker implantation was recorded. In the first ten patients, along right–left, anterior–posterior, and inferior–superior directions, MIFE was variable (mean±std=0.24±0.13.2emcm,0.31±0.14.2emcm,0.83±0.35.2emcm, respectively) and was at most 0.51, 0.53, and 1.56 cm, respectively. Along the same directions, μnormalM were 0.09,−0.05,−0.05.2emcm,μSD were 0.30, 0.17, 0.33 cm, and σres were 0.35, 0.26, and 0.30 cm, respectively. MIFE was not correlated with pM and pSD. In the five additional patients, it was possible to satisfy recommended dose limits, with the exception of slightly higher doses to small bowel. After bony alignment, the margins for target expansion can be obtained by adding personalized MIFE to the residual interfraction term. Using these margins, conformal free‐breathing irradiation is a reliable option for the treatment of pancreatic cancer.PACS number: 87.55.D‐

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Section: Methodsmentioning

confidence: 99%