Flattening Filter Free vs Flattened Beams for Breast Irradiation

Spruijt, Kees; Dahele, Max; Cuijpers, J.P.; Jeulink, Marloes; Rietveld, D.; Slotman, Ben J.; Verbakel, Wilko F.A.R.

doi:10.1016/j.ijrobp.2012.03.040

Cited by 62 publications

(60 citation statements)

References 14 publications

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“…[2627] As dose to organs close to the target, though the extent of improvement was much less, a better OAR protection for unflattened beams had also been confirmed by a number of authors. [9101426] According to Table 2, the results in our study generally support these reported data. Whereas, a similar planning study of advanced NPC cases using Eclipse TPS and Varian TrueBeam LINAC performed by Zhuang et al .…”

Section: Discussionsupporting

confidence: 89%

“…Up to now, BOT reduction of more than 70% had been reported in SRT treatment [12132829] and ~33% in breast and prostate treatment. [1415] The BOT in our study was ~24% less for FFF-VMAT plans, which was remarkably lower than the above mentioned data. Obviously, in terms of treatment time, treatments with small target size and less MLC movement could benefit more from the increased dose rate of the FFF beam.…”

Section: Discussioncontrasting

confidence: 76%

“…[8] During the past years, feasibility of treating various cancers including prostate, lung, larynx, chest wall, and esophagus using unflattened beams have been reported. [910111213141516] Also exclusive use of a linear accelerator in FFF mode in 3D CRT planning has also been reported to be feasible. [17] From all these published results, a reduced beam on time (BOT) and comparable plan quality seem to have been confirmed for VMAT plan with unflattened beams.…”

Section: Introductionmentioning

confidence: 99%

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A dosimetric evaluation of flattening filter-free volumetric modulated arc therapy in nasopharyngeal carcinoma

Song

et al. 2014

J Med Phys

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Purpose:To explore the dosimetric effects of flattening filter-free (FFF) beams in volumetric modulated arc therapy (VMAT) of nasopharyngeal carcinoma via a retrospective planning study.Materials and Methods:A linear accelerator (LINAC) was prepared to operate in FFF mode and the beam data were collected and used to build a model in TPS. For 10 nasopharyngeal carcinoma (NPC) cases, VMAT plans of FFF beams and normal flattened (FF) beams were designed. Differences of plan quality and delivery efficiency between FFF-VMAT plans and filter filtered VMAT (FF-VMAT) plans were analyzed using two-tailed paired t-tests.Results:Removal of the flattening filter increased the dose rate. Averaged beam on time (BOT) of FFF-VMAT plans was decreased by 24.2%. Differences of target dose coverage between plans with flattened and unflattened beams were statistically insignificant. For dose to normal organs, up to 4.9% decrease in V35 of parotid grand and 4.5% decrease in averaged normal tissue (NT) dose was observed.Conclusions:The TPS used in our study was able to handle FFF beams. The FFF beam prone to improve the normal tissue sparing while achieving similar target dose distribution. Decreasing of BOT in NPC cases was valuable in terms of patient's comfort.

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

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A dosimetric evaluation of flattening filter-free volumetric modulated arc therapy in nasopharyngeal carcinoma

Song

et al. 2014

J Med Phys

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“…For the FFF beams, with the use of the modulation effect of dynamic MLC in IMRT, the problem of a nonuniform, conical fluence distribution can be largely solved. Recent trials of FFF have demonstrated its applications in IMRT and stereotactic body radiotherapy (SBRT) for various malignant diseases 11–13. Apart from the potential reduction of treatment delivery time, our study aimed to evaluate the dosimetric impact of using FFF beams in IMRT for early-stage upper thoracic oesophageal cancer.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the dosimetric impact of applying flattening filter‐free beams in intensity‐modulated radiotherapy for early‐stage upper thoracic carcinoma of oesophagus

Zhang

Lin

et al. 2015

J of Medical Radiation Sci

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IntroductionFlattening filter-free (FFF) radiation beams have recently become clinically available on modern linear accelerators in radiation therapy. This study aimed to evaluate the dosimetric impact of using FFF beams in intensity-modulated radiotherapy (IMRT) for early-stage upper thoracic oesophageal cancer.MethodsEleven patients with primary stage upper thoracic oesophageal cancer were recruited. For each patient, two IMRT plans were computed using conventional beams (Con-P) and FFF beams (FFF-P), respectively. Both plans employed a five-beam arrangement and were prescribed with 64 Gy to (planning target volume) PTV1 and 54 Gy to PTV2 in 32 fractions using 6 MV photons. The dose parameters of the target volumes and organs at risks (OARs), and treatment parameters including the monitor units (MU) and treatment time (TT) for Con-P and FFF-P were recorded and compared.ResultsThe mean D5 of PTV1 and PTV2 were higher in FFF-P than Con-P by 0.4 Gy and 0.3 Gy, respectively. For the OARs, all the dose parameters did not show significant difference between the two plans except the mean V5 and V10 of the lung in which the FFF-P was lower (46.7% vs. 47.3% and 39.1% vs. 39.6%, respectively). FFF-P required 54% more MU but 18.4% less irradiation time when compared to Con-P.ConclusionThe target volume and OARs dose distributions between the two plans were comparable. However, FFF-P was more effective in sparing the lung from low dose and reduced the mean TT compared with Con-P. Long-term clinical studies are suggested to evaluate the radiobiological effects of FFF beams.

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“…[1][2][3][4][5] With the removal of the flattening filter which generates a uniform beam profile for 3D-conformal radiotherapy, the output of the photon beam is highly increased. 6,7 For example, the Varian TrueBEAM linear accelerator can produce 1400 monitor units (MU) and 2400 MU per minute for the 6 and 10 MV photon beams, respectively.…”

Section: Introductionmentioning

confidence: 99%

A surface energy spectral study on the bone heterogeneity and beam obliquity using the flattened and unflattened photon beams

Chow

Owrangi

2016

Reports of Practical Oncology & Radiotherapy

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Flattening Filter Free vs Flattened Beams for Breast Irradiation

Cited by 62 publications

References 14 publications

A dosimetric evaluation of flattening filter-free volumetric modulated arc therapy in nasopharyngeal carcinoma

A dosimetric evaluation of flattening filter-free volumetric modulated arc therapy in nasopharyngeal carcinoma

Evaluation of the dosimetric impact of applying flattening filter‐free beams in intensity‐modulated radiotherapy for early‐stage upper thoracic carcinoma of oesophagus

A surface energy spectral study on the bone heterogeneity and beam obliquity using the flattened and unflattened photon beams

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