Phase I dose escalation study using the deep inspiration breath hold technique to safely increase dose to 81 Gy in the treatment of inoperable non-small cell lung cancer

Rosenzweig, K.; Hanley, Jim; Mychalczak, Borys; Fuks, Zvi; Mageras, G.; Yorke, Ellen; Ling, C.C.; Burman, C; Ginsberg, Robert J.; Kris, Mark G.; Leibel, S.

doi:10.1016/s0360-3016(00)80260-6

Cited by 11 publications

(4 citation statements)

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“…A larger motion amplitude of 10/20 mm has been simulated only for one target size and for few selected repainting strategies and systems. For motion amplitudes above 5 mm gating, a breath-hold technique, tracking or phase-controlled rescanning methods could be used as a possible solution (Minohara et al 2000, Bert et al 2007, Hanley et al 1999, Rosenzweig et al 2000, Mah et al 2000, Seco et al 2009, Furukawa et al 2007. These methods will not only reduce the position error but also lead to a better dose conformation at the borders of the target.…”

Section: Motion Model and Motion Parametersmentioning

confidence: 99%

A study on repainting strategies for treating moderately moving targets with proton pencil beam scanning at the new Gantry 2 at PSI

2010

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Treating moving targets using a scanning gantry for proton therapy is a promising but very challenging, not yet clinically demonstrated treatment modality. The interference of organ motion with the sequence of the beam delivery produces uncontrolled dose inhomogeneities within the target. One promising approach to overcome this difficulty is to increase the speed of scanning in order to apply the dose repeatedly (so-called repainting). To obtain sufficiently high scanning speeds a new, technologically improved gantry-Gantry 2-has been designed and is currently under construction at PSI. As there are many possible repainting strategies, the way repainting will be implemented on Gantry 2 will depend on the result of a careful analysis of the various treatment delivery strategies available. To achieve this aim, and prior to the start of experimental work with Gantry 2, simulations of dose distribution errors due to organ motion under various beam delivery strategies were investigated. The effects of motion on the dose distribution were studied for moderate motion amplitudes (5 mm) for spherical target volumes in a homogeneous medium and with homogeneous dose. In total over 200,000 dose distributions have been simulated and analyzed and selected results are discussed. From the obtained results we are confident to be able to treat moderately moving targets on Gantry 2 using repainted pencil-beam spot scanning. Continuous line scanning seems to be the most elegant solution; it provides higher repainting rates and produces superior results but is probably more difficult to realize. For larger motion amplitudes, continuous line scanning still shows good results, but we plan anyways to use a gating system for these cases, not only to reduce the inhomogeneity within the target volume but also to reduce safety margins.

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Section: Motion Model and Motion Parametersmentioning

confidence: 99%

A study on repainting strategies for treating moderately moving targets with proton pencil beam scanning at the new Gantry 2 at PSI

2010

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“…Methods to limit or control breathing include normal (tide) breathing, breathing with commands at standard phases, breath holding at different phases, breath coaching, diaphragmatic compression etc. (Beyer et al 2003, Goerres et al 2002, Rosenzweig et al 2000. However, all methods using breath commands suffer from problems of either miscommunication with the imaging technologist or patient's non-compliance resulting from anxiety and/or advanced state of disease.…”

Section: Breathing Movementsmentioning

confidence: 99%

Biological imaging in radiation therapy: role of positron emission tomography

et al. 2008

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In radiation therapy (RT), staging, treatment planning, monitoring and evaluation of response are traditionally based on computed tomography (CT) and magnetic resonance imaging (MRI). These radiological investigations have the significant advantage to show the anatomy with a high resolution, being also called anatomical imaging. In recent years, so called biological imaging methods which visualize metabolic pathways have been developed. These methods offer complementary imaging of various aspects of tumour biology. To date, the most prominent biological imaging system in use is positron emission tomography (PET), whose diagnostic properties have clinically been evaluated for years. The aim of this review is to discuss the valences and implications of PET in RT. We will focus our evaluation on the following topics: the role of biological imaging for tumour tissue detection/delineation of the gross tumour volume (GTV) and for the visualization of heterogeneous tumour biology. We will discuss the role of fluorodeoxyglucose-PET in lung and head and neck cancer and the impact of amino acids (AA)-PET in target volume delineation of brain gliomas. Furthermore, we summarize the data of the literature about tumour hypoxia and proliferation visualized by PET. We conclude that, regarding treatment planning in radiotherapy, PET offers advantages in terms of tumour delineation and the description of biological processes. However, to define the real impact of biological imaging on clinical outcome after radiotherapy, further experimental, clinical and cost/benefit analyses are required.

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“…Breath-hold techniques include the deep-inspiration breath-hold (DIBH) technique and the active breathing control (ABC) technique. In the DIBH method, dose is delivered when patients achieve the maximum inspiration (Hanley et al 1999, Rosenzweig et al 2000, while in the ABC method, a spirometer is used to force patients to hold their breath at a pre-defined lung volume (Wong et al 1999). Breath-hold techniques may not be appropriate for lung cancer patients with poor pulmonary function since it is hard for them to tolerate a long breath-holding time.…”

Section: Introductionmentioning

confidence: 99%

Synchronized moving aperture radiation therapy (SMART): superimposing tumor motion on IMRT MLC leaf sequences under realistic delivery conditions

Xu¹,

Papanikolaou²,

Shi³

et al. 2009

Phys. Med. Biol.

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Synchronized moving aperture radiation therapy (SMART) has been proposed to account for tumor motions during radiotherapy in prior work. The basic idea of SMART is to synchronize the moving radiation beam aperture formed by a dynamic multileaf collimator (DMLC) with the tumor motion induced by respiration. In this paper, a two-dimensional (2D) superimposing leaf sequencing method is presented for SMART. A leaf sequence optimization strategy was generated to assure the SMART delivery under realistic delivery conditions. The study of delivery performance using the Varian LINAC and the Millennium DMLC showed that clinical factors such as collimator angle, dose rate, initial phase and machine tolerance affect the delivery accuracy and efficiency. An in-house leaf sequencing software was developed to implement the 2D superimposing leaf sequencing method and optimize the motion-corrected leaf sequence under realistic clinical conditions. The analysis of dynamic log (Dynalog) files showed that optimization of the leaf sequence for various clinical factors can avoid beam hold-offs which break the synchronization of SMART and fail the SMART dose delivery. Through comparison between the simulated delivered fluence map and the planed fluence map, it was shown that the motion-corrected leaf sequence can greatly reduce the dose error.

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Phase I dose escalation study using the deep inspiration breath hold technique to safely increase dose to 81 Gy in the treatment of inoperable non-small cell lung cancer

Cited by 11 publications

References 0 publications

A study on repainting strategies for treating moderately moving targets with proton pencil beam scanning at the new Gantry 2 at PSI

A study on repainting strategies for treating moderately moving targets with proton pencil beam scanning at the new Gantry 2 at PSI

Biological imaging in radiation therapy: role of positron emission tomography

Synchronized moving aperture radiation therapy (SMART): superimposing tumor motion on IMRT MLC leaf sequences under realistic delivery conditions

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