Plan robustness in field junction region from arcs with different patient orientation in total marrow irradiation with VMAT

Mancosu, P.; Navarria, Pierina; Castagna, Luca; Reggiori, G.; Stravato, A.; Gaudino, A.; Sarina, Barbara; Tomatis, S.; Scorsetti, Marta

doi:10.1016/j.ejmp.2015.05.012

Cited by 35 publications

(45 citation statements)

References 23 publications

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“…It can be argued that this approach better reflects the reality of a clinical department; however we have deliberately chosen more direct observables which allow for easier analysis. A 21% increase of the maximum dose reported in [26] is however close to the expected value of 25% for a 5 mm shift in the cranio-caudal direction applied to a 20 mm overlap region.…”

Section: Maximal Vs Average Positional Errorssupporting

confidence: 71%

“…Consequently, we limited our study to the cranio-caudal direction. A comparision of the dosimetric changes reported in [26,27] to the ones reported here is difficult for two reasons: (a) we examined local effects (hot-and cold spots) rather than their influence on the volume-dose histogram, and (b) we evaluated the dosimetric impact of the maximal shift, i.e., ±5 mm, while the authors in [26,27] chose three random values from the [−5 mm, +5 mm] range and used their mean and standard deviation. Assuming that the samples are distributed uniformly, the mean of several uniform distribution is a rectangular mean distribution, sometimes called Bates distribution.…”

Section: Maximal Vs Average Positional Errorsmentioning

confidence: 99%

“…However, a recent study [26] dealing with the robustness of treatment plans with respect to positional shifts of the patient claims that the authors specifically aimed for a sigmoidal dose profile in the field overlap region. In another study on localization errors [11] the authors propose a staircase dose profile in order to minimize such errors.…”

Section: Dose Profile In Field Overlap Areamentioning

confidence: 99%

See 2 more Smart Citations

Reducing the dosimetric impact of positional errors in field junctions for craniospinal irradiation using VMAT

Strojnik

Méndez

Peterlin

2016

Reports of Practical Oncology & Radiotherapy

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Section: Maximal Vs Average Positional Errorssupporting

confidence: 71%

Section: Maximal Vs Average Positional Errorsmentioning

confidence: 99%

Section: Dose Profile In Field Overlap Areamentioning

confidence: 99%

See 1 more Smart Citation

Reducing the dosimetric impact of positional errors in field junctions for craniospinal irradiation using VMAT

Strojnik

Méndez

Peterlin

2016

Reports of Practical Oncology & Radiotherapy

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“…By introducing an optimised shallow gradient of the abutting fields at the junction, the robustness is greatly improved. A very similar approach has been described by Mancosu et al in their TMI approach using VMAT [25].…”

Section: Discussionmentioning

confidence: 97%

Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy – A practical guide

et al. 2019

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Total Marrow Irradiation (TMI) with Helical Tomotherapy is a radiotherapy treatment technique that targets bone marrow and sanctuary sites prior to stem cell or bone marrow transplantation (SCT/BMT). TMI is a complex procedure that involves several critical steps that all need to be carefully addressed for a successful implementation, such as dose homogeneity in field junctions, choice of target margins, integrity of treatment and backup planning. In this work we present our solution for a robust and reproducible workflow throughout the treatment chain and data for twenty-three patients treated to date. Material & Methods: Patients were immobilized in a whole body vacuum cushion and thermoplastic mask. CTscanning and treatment were performed in two parts with field matching at the upper thigh. Target consisted of marrow containing bone and sanctuary sites. Lungs, kidneys, bowel, heart and liver were defined as organs at risk (OAR). A fast surface scanning system was used to position parts of the body not covered by the imaging system (MVCT) as well as to reduce treatment time. Results: All patients completed their treatment and could proceed with SCT/BMT. Doses to OARs were significantly reduced and target dose homogeneity was improved compared to TBI. Robustness tests performed on field matching and patient positioning support that the field junction technique is adequate. Replacing MVCT with optical surface scanning reduced the treatment time by 25 min per fraction. Conclusion: The methodology presented here has shown to provide a safe, robust and reproducible treatment for Total Marrow Irradiation using Tomotherapy.

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“…Papers published in English between 2010 and 2018 were included. Twelve papers were identified [21][22][23][24][25][26][27][28][29][30][31][32] ( Table 2). In particular, the papers covered feasibility planning studies [21][22]30,32], optimization of the plan parameters [24,28,30,31], plan optimization of the lower extremities [28], plan robustness [27,28,32], and dosimetric plan verification [21,22,25,26,29,32].…”

Section: Search Strategymentioning

confidence: 99%

Total marrow irradiation for hematopoietic malignancies using volumetric modulated arc therapy: A review of treatment planning studies

Mancosu¹,

Cozzi

Muren

2019

Physics and Imaging in Radiation Oncology

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Total Marrow Irradiation (TMI) has been introduced in the management of hematopoietic malignancies with the aim of reducing toxicities induced by total body irradiation. TMI is one of the most challenging planning and delivery techniques of radiotherapy, as the whole skeleton should be irradiated, while sparing nearby organs at risk (OARs). Target volumes of 7-10 k cm 3 and healthy tissue volumes of 50-90 k cm 3 should be considered and inverse treatment planning is needed. This review focused on aspects of TMI delivery using volumetric modulated arc therapy (VMAT). In particular, multiple arcs from isocenters with different positions are required for VMAT-TMI as the cranial-caudal lengths of patients are much larger than the jaw aperture. Therefore, many field junctions between arcs with different isocenters should be managed. This review covered, in particular, feasibility studies for managing multiple isocenters, optimization of plan parameters, plan optimization of the lower extremities, robustness of field junctions and dosimetric plan verification of VMAT-TMI. This review demonstrated the possibility of VMAT in delivering TMI with multi-arcs and multi-isocenters. Care should be paid in the patient repositioning, with particular attention to the cranial-caudal direction.

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Plan robustness in field junction region from arcs with different patient orientation in total marrow irradiation with VMAT

Cited by 35 publications

References 23 publications

Reducing the dosimetric impact of positional errors in field junctions for craniospinal irradiation using VMAT

Reducing the dosimetric impact of positional errors in field junctions for craniospinal irradiation using VMAT

Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy – A practical guide

Total marrow irradiation for hematopoietic malignancies using volumetric modulated arc therapy: A review of treatment planning studies

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