Lattice Radiation Therapy in clinical practice: A systematic review

Iori, Federico; Cappelli, Anna; D’Angelo, Elisa; Cozzi, Salvatore; Ghersi, Sebastiano Finocchi; Felice, Francesca De; Ciammella, Patrizia; Bruni, Alessio; Iotti, C.

doi:10.1016/j.ctro.2022.100569

Cited by 13 publications

(18 citation statements)

References 20 publications

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“…An upfront single fraction was prescribed with the intent to combine the LRT treatment with a consolidation treatment of 20 Gy in five fractions. This prescription method was chosen over the exclusive treatment with simultaneous integrated boost because of its flexibility as this sequential treatment may be delivered in one or many fractions and combined with a conventional or hypofractionated treatment 4 …”

Section: Methodsmentioning

confidence: 99%

“…LRT is typically used for tumor cytoreduction intent in bulky tumors where larger doses may not be safely delivered, often in a palliative setting. LRT has been reported to result in a median tumor reduction of more than 50% and to be well tolerated by patients 4 …”

Section: Introductionmentioning

confidence: 99%

“…A large number of vertices must be generated inside the target, and this number increases with tumor size. Earlier works inserted vertices at arbitrary locations, which complicates the comparison with other studies 4 . Furthermore, dose optimization requires online refinement of planning objectives on a vertex basis, a time‐consuming process if many iterations are needed to obtain a suitable treatment plan.…”

Section: Introductionmentioning

confidence: 99%

“…LRT has been reported to result in a median tumor reduction of more than 50% and to be well tolerated by patients. 4 Two approaches to delivering LRT are commonly used. The first approach consists of a sole LRT treatment course with a simultaneous integrated boost, usually delivered in five fractions.…”

Section: Introductionmentioning

confidence: 99%

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Development of an automated treatment planning approach for lattice radiation therapy

Gaudreault,

Chang,

Kron

et al. 2023

Medical Physics

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BackgroundLattice radiation therapy (LRT) alternates regions of high and low doses within the target. The heterogeneous dose distribution is delivered to a geometrical structure of vertices segmented inside the tumor. LRT is typically used to treat patients with large tumor volumes with cytoreduction intent. Due to the geometric complexity of the target volume and the required dose distribution, LRT treatment planning demands additional resources, which may limit clinical integration.PurposeWe introduce a fully automated method to (1) generate an ordered lattice of vertices with various sizes and center‐to‐center distances and (2) perform dose optimization and calculation. We aim to report the dosimetry associated with these lattices to help clinical decision‐making.MethodsSarcoma cancer patients with tumor volume between 100 cm3 and 1500 cm3 who received radiotherapy treatment between 2010 and 2018 at our institution were considered for inclusion. Automated segmentation and dose optimization/calculation were performed by using the Eclipse Scripting Application Programming Interface (ESAPI, v16, Varian Medical Systems, Palo Alto, USA). Vertices were modeled by spheres segmented within the gross tumor volume (GTV) with 1 cm/1.5 cm/2 cm diameters (LRT‐1 cm/1.5 cm/2 cm) and 2 to 5 cm center‐to‐center distance on square lattices alternating along the superior‐inferior direction. Organs at risk were modeled by subtracting the GTV from the body structure (body‐GTV). The prescription dose was that 50% of the vertice volume should receive at least 20 Gy in one fraction. The automated dose optimization included three stages. The vertices optimization objectives were refined during optimization according to their values at the end of the first and second stages. Lattices were classified according to a score based on the minimization of body‐GTV max dose and the maximization of GTV dose uniformity (measured with the equivalent uniform dose [EUD]), GTV dose heterogeneity (measured with the GTV D90%/D10% ratio), and the number of patients with more than one vertex inserted in the GTV. Plan complexity was measured with the modulation complexity score (MCS). Correlations were assessed with the Spearman correlation coefficient (r) and its associated p‐value.ResultsThirty‐three patients with GTV volumes between 150 and 1350 cm3 (median GTV volume = 494 cm3, IQR = 272–779 cm3 were included. The median time required for segmentation/planning was 1 min/21 min. The number of vertices was strongly correlated with GTV volume in each LRT lattice for each center‐to‐center distance (r > 0.85, p‐values < 0.001 in each case). Lattices with center‐to‐center distance = 2.5 cm/3 cm/3.5 cm in LRT‐1.5 cm and center‐to‐center distance = 4 cm in LRT‐1 cm had the best scores. These lattices were characterized by high heterogeneity (median GTV D90%/D10% between 0.06 and 0.19). The generated plans were moderately complex (median MCS ranged between 0.19 and 0.40).ConclusionsThe automated LRT planning method allows for the efficacious generation of vertices arranged in an ordered lattice and the refinement of planning objectives during dose optimization, enabling the systematic evaluation of LRT dosimetry from various lattice geometries.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Development of an automated treatment planning approach for lattice radiation therapy

Gaudreault,

Chang,

Kron

et al. 2023

Medical Physics

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“…Besides, laparoscopic tissue expander inserted into the lower pelvis for removing the intestinal tract out of the radiation field, which can effectively prevent radiation enteritis (Omejc et al, 2021). Lattice Radiation Therapy is a spatially fractionated radiotherapy technique that allows simultaneously deliver sufficient ablation dose to the inside neoplastic lesions and low dose to adjacent organs (Iori et al, 2023).…”

Section: Precaution Of Radiation Enteritismentioning

confidence: 99%

Pathogenesis and therapy of radiation enteritis with gut microbiota

et al. 2023

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Radiotherapy is widely used in clinic due to its good effect for cancer treatment. But radiotherapy of malignant tumors in the abdomen and pelvis is easy to cause radiation enteritis complications. Gastrointestinal tract contains numerous microbes, most of which are mutualistic relationship with the host. Abdominal radiation results in gut microbiota dysbiosis. Microbial therapy can directly target gut microbiota to reverse microbiota dysbiosis, hence relieving intestinal inflammation. In this review, we mainly summarized pathogenesis and novel therapy of the radiation-induced intestinal injury with gut microbiota dysbiosis and envision the opportunities and challenges of radiation enteritis therapy.

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Semi‐automated vertex placement for lattice radiotherapy and dosimetric verification using 3D polymer gel dosimetry

Kunkyab,

Magliari,

Jirasek

et al. 2024

J Applied Clin Med Phys

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PurposeTo evaluate the feasibility of an open‐source, semi‐automated, and reproducible vertex placement tool to improve the efficiency of lattice radiotherapy (LRT) planning. We used polymer gel dosimetry with a Cone Beam CT (CBCT) readout to commission this LRT technique.Material and methodsWe generated a volumetric modulated arc therapy (VMAT)‐based LRT plan on a 2 L NIPAM polymer gel dosimeter using our Eclipse Acuros version 15.6 AcurosXB beam model, and also recalculated the plan with a pre‐clinical Acuros v18.0 dose calculation algorithm with the enhanced leaf modelling (ELM). With the assistance of the MAAS‐SFRThelper software, a lattice vertex diameter of 1.5 cm and center‐to‐center spacing of 3 cm were used to place the spheres in a hexagonal, closed packed structure. The verification plan included four gantry arcs with 15°, 345°, 75°, 105° collimator angles. The spheres were prescribed 20 Gy to 50% of their combined volume. The 6 MV Flattening Filter Free beam energy was used to deliver the verification plan. The dosimetric accuracy of the LRT delivery was evaluated with 1D dose profiles, 2D isodose maps, and a 3D global gamma analysis.ResultsQualitative comparisons between the 1D dose profiles of the Eclipse plan and measured gel showed good consistency at the prescription dose mark. The average diameter measured 13.3 ± 0.2 mm (gel for v15.6), 12.6 mm (v15.6 plan), 13.1 ± 0.2 mm (gel for v18.0), and 12.3 mm (v18.0 plan). 3D gamma analysis showed that all gamma pass percent were > 95% except at 1% and 2% at the 1 mm distance to agreement criteria.ConclusionThis study presents a novel application of gel dosimetry in verifying the dosimetric accuracy of LRT, achieving excellent 3D gamma results. The treatment planning was facilitated by publicly available software that automatically placed the vertices for consistency and efficiency.

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Lattice Radiation Therapy in clinical practice: A systematic review

Cited by 13 publications

References 20 publications

Development of an automated treatment planning approach for lattice radiation therapy

Development of an automated treatment planning approach for lattice radiation therapy

Pathogenesis and therapy of radiation enteritis with gut microbiota

Semi‐automated vertex placement for lattice radiotherapy and dosimetric verification using 3D polymer gel dosimetry

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