Improved outcome of treating locally advanced lung cancer with the use of Lattice Radiotherapy (LRT): A case report

Amendola, Beatriz E.; Pérez, Naipy; Wu, Xiaodong; Suárez, José; Lu, Jiade J.; Amendola, Marco A.

doi:10.1016/j.ctro.2018.01.003

Cited by 27 publications

(40 citation statements)

References 11 publications

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“…The simulated results showed acceptable peak-to-valley dose differences can be achieved with the three different sizes of breast phantoms. [4][5][6][7][8] As the phantom size increases, the number of shots in the phantom also increase. There were 22, 75, and 172 shots total for the 10, 15, and 20 cm phantom diameters, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The ratios were within or better than the recommended ratio range 0.7 to 0.8 for the shot spacing chosen in previous studies. [4][5][6][7][8] The planned shot locations were not optimized to achieve a specific ratio, but instead were planned to achieve symmetric lateral spacing. This spacing allows for a large low dose volume compared to the volume that receives at least half of the maximum planned dosage.…”

Section: Discussionmentioning

confidence: 99%

“…The spacing used was based off the effective use in other treatment sites. 5,8 This is motivated by GRID treatment achieving similar clinical effectiveness with the same spacing across different sites. 1 As the same biological principles are in effect across sites, a similar spacing that achieves similar dose characteristics such as a high peak-tovalley dose difference will show the feasibility of LRT.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, we chose a shot spacing of 3.5 cm in the sagittal planes and 3.0 cm in the coronal planes in order to achieve acceptable peaks-to-valley dose ratios. [4][5][6][7][8] A total of nine shots were delivered on a central vertical plane which created a 3 × 3 grid. A Monte-Carlo simulation of the nine shots with 15 mm collimators was also created for comparison.…”

Section: Methodsmentioning

confidence: 99%

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Technical Note: Dosimetric feasibility of lattice radiotherapy for breast cancer using GammaPod

Kopchick

Niu

et al. 2020

Medical Physics

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Purpose: Studies on Lattice radiotherapy (LRT) for breast cancer have been largely lacking. This study investigates the dosimetric feasibility of using Gamma Pod, a stereotactic radiotherapy apparatus originally designed for breast SBRT, to deliver LRT to large, bulky breast tumor as a noninvasive treatment option. Methods: The GammaPod-based LRT was simulated using Geant4 Gate Monte Carlo software. The simulated GammaPod was equipped with 5 mm diameter non-coplanar circular beams that span 28°l atitudinally from 18°to 43°off the horizontal plane. Two degrees longitudinal intervals were used to simulate rotating sources. To simulate the treatments to different breast sizes, three water-equivalent hemisphere volumes with diameters of 10, 15, and 20 cm were analyzed. The lattice was planned by spacing focal points 2 cm apart in the transverse and sagittal planes and 2.5 cm in the coronal plane. This resulted in 22-172 shots for full breast treatment. The maximum dose for each individual shot was 20 Gy. The peak-to-valley dose differences and skin dose were analyzed. To verify the feasibility of delivering LRT, a test plan was created and delivered to a commercial diode array dose verification device using a clinical GammaPod system with 15 mm collimators. Results: The dose profiles showed the average peak-to-valley dose percent differences of 94.10% in the 10 cm hemispherical volume, 88.95% in the 15 cm hemispherical volume, and 83.60% in the 20 cm hemispherical volume. Average skin dose was 1.27, 1.72, and 2.13 Gy for the 10, 15, and 20 cm irradiation volumes, respectively. The LRT plan delivered using a clinical GammaPod system with larger collimators verified the feasibility of LRT plan delivery. Conclusion: GammaPod-based lattice radiotherapy is a viable treatment option and its application can be extended to treating large bulky breast tumors.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Technical Note: Dosimetric feasibility of lattice radiotherapy for breast cancer using GammaPod

Kopchick

Niu

et al. 2020

Medical Physics

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“…The Lattice SBRT planning technique was based on previously published approaches, which used boost target vertices of 1-2 cm in diameter spaced 2-3 cm apart throughout the GTV [13], [14]. Multiple combinations of target vertices (1-2 cm) and inter-vertex distances (2-4 cm) were tested.…”

Section: Methodsmentioning

confidence: 99%

Spatially fractionated stereotactic body radiotherapy (Lattice SBRT) for large tumors

Duriseti

Kavanaugh

Goddu

et al. 2020

Preprint

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Stereotactic body radiotherapy (SBRT) has demonstrated clinical benefit for patients with metastatic and/or unresectable cancer. Technical considerations of treatment delivery and sensitive organs at risk (OARs) limit the use of SBRT in large tumors or those in unfavorable locations. Spatially fractionated radiotherapy (SFRT) delivers high-dose radiation to discrete sub-volume vertices within a tumor target while restricting the remainder of the target to low dose. SFRT has been utilized for treatment of large tumors with reported dramatic tumor response and minimal side effects. Lattice is a modern approach to SFRT that can be delivered with arc-based therapy, which allows for the rapid dose fall-off required for high quality SBRT. In order to overcome the limitations of SBRT for large tumors, we developed Lattice SBRT. Here we report the results of a dosimetry and quality assurance (QA) feasibility study of Lattice SBRT in 11 patients with 12 tumor targets, each ≥ 10 cm in an axial dimension. Prior CT simulation scans were used to generate volumetric-modulated arc therapy (VMAT) Lattice SBRT plans that were then delivered on clinically available Linacs. QA testing included external portal imaging device (EPID) and ion chamber (IC) analysis. All generated plans were able to meet the standard SBRT dose constraints, such as those from AAPM Task Group 101. Additionally, we provide a step-by-step approach for generating and delivering Lattice SBRT plans using commercially available treatment technology. Lattice SBRT is currently being tested in a prospective trial for patients with metastatic cancer needing palliation of a large tumor (NCT04133415).

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Lattice position optimization for LATTICE therapy

et al. 2023

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BackgroundLATTICE radiation therapy delivers 3D heterogenous dose of high peak‐to‐valley dose ratio (PVDR) to the tumor target, with peak dose at lattice vertices inside the target and valley dose for the rest of the target. Although the lattice vertex positions can impact PVDR inside the target and sparing of organs‐at‐risk (OAR), they are fixed as constants and not optimized during treatment planning in current clinical practice.PurposeThis work proposes a new LATTICE plan optimization method that can optimize lattice vertex positions during LATTICE treatment planning, which is the first lattice position optimization study to the best of our knowledge.MethodsThe new LATTICE treatment planning method optimizes lattice vertex positions as well as other plan variables (e.g., photon fluences or proton spot weights), with optimization objectives for target PVDR and OAR sparing. To satisfy mathematical differentiability, the lattice vertices are approximated in sigmoid functions. For geometric feasibility, proper geometry constraints are enforced onto lattice vertex positions. The lattice position optimization problem is solved by iterative convex relaxation (ICR) method and alternating direction method of multipliers (ADMM), and lattice vertex positions and photon/proton plan variables are jointly updated via the Quasi‐Newton method.ResultsBoth photon and proton LATTICE RT were considered, and the optimal lattice vertex positions in terms of plan objectives were found by solving all possible combinations on given discrete positions via exhaustive searching based on standard IMRT/IMPT, which served as the ground truth for validating the new LATTICE method. The results show that the new method indeed provided the optimal lattice vertex positions with the smallest optimization objective, the largest target PVDR, and the best OAR sparing.ConclusionsA new LATTICE treatment planning method is proposed and validated that can optimize lattice vertex positions as well as other photon or proton plan variables for improving target PVDR and OAR sparing.

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Improved outcome of treating locally advanced lung cancer with the use of Lattice Radiotherapy (LRT): A case report

Cited by 27 publications

References 11 publications

Technical Note: Dosimetric feasibility of lattice radiotherapy for breast cancer using GammaPod

Technical Note: Dosimetric feasibility of lattice radiotherapy for breast cancer using GammaPod

Spatially fractionated stereotactic body radiotherapy (Lattice SBRT) for large tumors

Lattice position optimization for LATTICE therapy

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