Fast Arc Delivery for Stereotactic Body Radiotherapy of Vertebral and Lung Tumors

Ong, C.L.; Verbakel, Wilko F.A.R.; Dahele, Max; Cuijpers, J.P.; Slotman, Ben J.; Senan, Suresh

doi:10.1016/j.ijrobp.2011.12.014

Cited by 70 publications

(78 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9,12,43 Because the difference in beam-on time may differ with different fraction schemes, we analysed it by use of three widely used fraction schemes. All of the fraction schemes were widely introduced for clinical use in recent publications and RTOG guideline.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11] FFF beams are characterized by high dose rate and are most frequently utilized for treatments where higher fraction dose is delivered, including hypofractionated SBRT for NSCLC, liver and other sites. [9][10][11][12] 6XFFF and 10XFFF are the only FFF beam modes in Varian's TrueBeam™ accelerator (Varian® Medical Systems), and they are both widely used in SBRT treatment for lung cancer. 9,10,[12][13][14] It is well known that the 10XFFF beam is produced with a dose rate of up to 2400 monitor units (MU) min 21 than 1400 MU min 21 for 6XFFF beam and consequently improves the treatment efficiency.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12] 6XFFF and 10XFFF are the only FFF beam modes in Varian's TrueBeam™ accelerator (Varian® Medical Systems), and they are both widely used in SBRT treatment for lung cancer. 9,10,[12][13][14] It is well known that the 10XFFF beam is produced with a dose rate of up to 2400 monitor units (MU) min 21 than 1400 MU min 21 for 6XFFF beam and consequently improves the treatment efficiency. 9,13,14 However, the treatment efficiency is not the only factor that needs taking into account for SBRT treatment, the organs at risk (OARs) sparing is equally important and also worthy of considering according to radiation therapy oncology group (RTOG) 0915 report.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, many publications reported the clinical feasibility of FFF beams for SBRT treatment of NSCLC; [9][10][11][12][13] however, the most suitable fraction scheme for peripheral lung lesion is still questionable. Lower dose fraction schemes will narrow the treatment efficiency difference between the 6XFFF and 10XFFF beams according to our preliminary experiences.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Optimizing the flattening filter free beam selection in RapidArc®-based stereotactic body radiotherapy for Stage I lung cancer

Jy¹,

Lin²,

Px³

et al. 2015

BJR

View full text Add to dashboard Cite

Jia-Yang Lu and Zhu Lin contributed equally to this work.Objective: To optimize the flattening filter-free (FFF) beam selection in stereotactic body radiotherapy (SBRT) treatment for Stage I lung cancer in different fraction schemes. Methods: Treatment plans from 12 patients suffering from Stage I lung cancer were designed using the 6XFFF and 10XFFF beams in different fraction schemes of 4 3 12, 3 3 18 and 1 3 34 Gy. Plans were evaluated mainly in terms of organs at risk (OARs) sparing, normal tissue complication probability (NTCP) estimation and treatment efficiency.Results: Compared with the 10XFFF beam, 6XFFF beam showed statistically significant lower dose to all the OARs investigated. The percentage of NTCP reduction for both lung and chest wall was about 10% in the fraction schemes of 4 3 12 and 3 3 18 Gy, whereas only 7.4% and 2.6% was obtained in the 1 3 34 Gy scheme. For oesophagus, heart and spinal cord, the reduction was greater with the 6XFFF beam, but their absolute estimates were ,10 26 %. The mean beam-on time for 6XFFF and 10XFFF beams at 4 3 12, 3 3 18 and 1 3 34 Gy schemes were 2.2 6 0.2 vs 1.5 6 0.1, 3.3 6 0.9 vs 2.0 6 0.5 and 6.3 6 0.9 vs 3.5 6 0.4 min, respectively. Conclusion: The 6XFFF beam obtains better OARs sparing and lower incidence of NTCP in SBRT treatment of Stage I lung cancer, whereas the 10XFFF beam improves the treatment efficiency. To balance the OARs sparing and intrafractional variation owing to the prolonged treatment time, the authors recommend using the 6XFFF beam in the 4 3 12 and 3 3 18 Gy schemes but the 10XFFF beam in the 1 3 34 Gy scheme. Advances in knowledge: This study optimizes the FFF beam selection in different fraction schemes in SBRT treatment of Stage I lung cancer. INTRODUCTIONLung cancer is the first and second leading cause of cancer death both in males and females, respectively, accounting for 13% of the total cases and 18% of deaths in 2008.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Optimizing the flattening filter free beam selection in RapidArc®-based stereotactic body radiotherapy for Stage I lung cancer

Jy¹,

Lin²,

Px³

et al. 2015

BJR

View full text Add to dashboard Cite

show abstract

“…Weksberg et al [18] produced a generalisable class solution to plan spine metastases, but only the involved vertebra was treated to a single dose. Other studies reported using VMAT or IMRT for treating spine metastases [19][20][21][22][23][24][25][26]. However, all the studies were on treating a single volume, and two studies [19,20] were on reirradiation where the prescription dose is dependent on the initial treatment.…”

Section: Discussionmentioning

confidence: 99%

Comparison of deliverable IMRT and VMAT for spine metastases using a simultaneous integrated boost

Lee

Bedford²,

McNair³

et al. 2013

BJR

View full text Add to dashboard Cite

Objective: To effectively treat spine metastases, significant dose must be delivered to regions surrounding the spinal cord. We present a study comparing both step-and-shoot intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques to deliver a concomitant hypofractionated prescription dose to the diseased region and to the involved vertebrae.Methods: Seven-field IMRT and a single arc VMAT were inversely planned on five (two cervical and three thoracic) spinal metastatic patients. Planning target volumes PTVm (macroscopic) and PTVe (elective involved vertebrae) and associated organs at risk were localised. Mean doses of 35 Gy to PTVm and 20 Gy to PTVe were prescribed in five fractions. Dose statistics, estimated delivery time and results of verification using Delta 4 (ScandiDos, Uppsala, Sweden) were compared.Results: Deliverable plans were achieved with both IMRT and VMAT. The coverage to PTV was similar for both IMRT and VMAT (p50.5) and the dose to the regions adjacent to the spinal cord was 1% higher with VMAT (p50.04). The mean delivery time for VMAT was 3.5min compared with 10.5min for IMRT. Fewer monitor units were required to deliver IMRT than to deliver VMAT. The median (range) percentage of measured points with a g-index ,1 with 3%/3 mm was 100 (99.9-100)% for IMRT and 100 (88.5-100)% for VMAT.Conclusion: Both VMAT and IMRT can deliver the concomitant hypofractionated regime proposed, and both offer different benefits in dose delivery. IMRT is currently preferred for its superior pre-treatment verification results and shorter planning times. Advances in knowledge:This study explores the feasibility of delivering tumouricidal doses of radiation to metastatic spine disease in the vicinity of the spinal cord.

show abstract

Improvement of conformal arc plans by using deformable margin delineation method for stereotactic lung radiotherapy

Güngör

Demir

Aydin

et al. 2017

J Applied Clin Med Phys

View full text Add to dashboard Cite

PurposeStereotactic body radiotherapy (SBRT) is an established treatment technique in the management of medically inoperable early stage non–small cell lung cancer (NSCLC). Different techniques such as volumetric modulated arc (VMAT) and three‐dimensional conformal arc (DCA) can be used in SBRT. Previously, it has been shown that VMAT is superior to DCA technique in terms of plan evaluation parameters. However, DCA technique has several advantages such as ease of use and considerable shortening of the treatment time. DCA technique usually results in worse conformity which is not possible to ameliorate by inverse optimization. In this study, we aimed to analyze whether a simple method – deformable margin delineation (DMD) – improves the quality of the DCA technique, reaching similar results to VMAT in terms of plan evaluation parameters.MethodsTwenty stage I–II (T1‐2, N0, M0) NSCLC patients were included in this retrospective dosimetric study. Noncoplanar VMAT and conventional DCA plans were generated using 6 MV and 10 MV with flattening filter free (FFF) photon energies. The DCA plan with 6FFF was calculated and 95% of the PTV was covered by the prescription isodose line. Hot dose regions (receiving dose over 100% of prescription dose) outside PTV and cold dose regions (receiving dose under 100% of prescription dose) inside PTV were identified. A new PTV (PTV‐DMD) was delineated by deforming PTV margin with respect to hot and cold spot regions obtained from conventional DCA plans. Dynamic multileaf collimators (MLC) were set to PTV‐DMD beam eye view (BEV) positions and the new DCA plans (DCA‐DMD) with 6FFF were generated. Three‐dimensional (3D) dose calculations were computed for PTV‐DMD volume. However, the prescription isodose was specified and normalized to cover 95% volume of original PTV. Several conformity indices and lung doses were compared for different treatment techniques.Results DCA‐DMD method significantly achieved a superior conformity index (CI), conformity number (CIP addick), gradient index (R50%), isodose at 2 cm (D2 cm) and external index (CΔ) with respect to VMAT and conventional DCA plans (P < 0.05 for all comparisons). CI ranged between 1.00–1.07 (Mean: 1.02); 1.00–1.18 (Mean: 1.06); 1.01–1.23 (Mean 1.08); 1.03–1.29 (Mean: 1.15); 1.04–1.29 (Mean: 1.18) for DCA‐DMD‐6FFF, VMAT‐6FFF, VMAT‐10FFF DCA‐6FFF and DCA‐10FFF respectively. DCA‐DMD‐6FFF technique resulted significantly better CI compared to others (P = 0.002; < 0.001; < 0.001; < 0.001). R50% ranged between 3.22–4.74 (Mean: 3.99); 3.24–5.92 (Mean: 4.15) for DCA‐DMD‐6FFF, VMAT‐6FFF, respectively. DCA‐DMD‐6FFF technique resulted lower intermediate dose spillage compared to VMAT‐6FFF, though the difference was statistically insignificant (P = 0.32). D2 cm ranged between 35.7% and 67.0% (Mean: 53.2%); 42.1%–79.2% (Mean: 57.8%) for DCA‐DMD‐6FFF, VMAT‐6FFF respectively. DCA‐DMD‐6FFF have significantly better and sharp falloff gradient 2 cm away from PTV compared to VMAT‐6FFF (P = 0.009). CΔ ranged between 0.052 and 0.140 (Mean: 0.085); ...

show abstract

Fast Arc Delivery for Stereotactic Body Radiotherapy of Vertebral and Lung Tumors

Cited by 70 publications

References 23 publications

Optimizing the flattening filter free beam selection in RapidArc®-based stereotactic body radiotherapy for Stage I lung cancer

Optimizing the flattening filter free beam selection in RapidArc®-based stereotactic body radiotherapy for Stage I lung cancer

Comparison of deliverable IMRT and VMAT for spine metastases using a simultaneous integrated boost

Improvement of conformal arc plans by using deformable margin delineation method for stereotactic lung radiotherapy

Contact Info

Product

Resources

About