Enhancing Delivery Efficiency on the Magnetic Resonance-Linac: A Comprehensive Evaluation of Prostate Stereotactic Body Radiation Therapy Using Volumetric Modulated Arc Therapy.

IF 6.4 1区 医学 Q1 ONCOLOGY
Jeffrey E Snyder, Martin F Fast, Prescilla Uijtewaal, Pim T S Borman, Peter Woodhead, Joël St-Aubin, Blake Smith, Andrew Shepard, Bas W Raaymakers, Daniel E Hyer
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引用次数: 0

Abstract

Purpose: Long treatment sessions are a limitation within magnetic resonance imaging guided adaptive radiation therapy (MRIgART). This work aims for significantly enhancing the delivery efficiency on the magnetic resonance linear accelerator (MR-linac) by introducing dedicated optimization and delivery techniques for volumetric modulated arc therapy (VMAT). VMAT plan and delivery quality during MRIgART is compared with step-and-shoot intensity-modulated radiation therapy (IMRT) for prostate stereotactic body radiation therapy.

Methods and materials: Ten patients with prostate cancer previously treated on a 1.5T MR-linac were retrospectively replanned to 36.25 Gy in 5 fractions using step-and-shoot IMRT and the clinical Hyperion optimizer within Monaco (Hyp-IMRT), the same optimizer with a VMAT technique (Hyp-VMAT), and a research-based optimizer called optimal fluence levels and pseudo gradient descent with VMAT (OFL+PGD-VMAT). The plans were then adapted onto each daily magnetic resonance imaging data set using 2 different optimization strategies to evaluate the adapt-to-position workflow: "optimize weights" (IMRT-Weights and VMAT-Weights) and "optimize shapes" (IMRT-Shapes and VMAT-Shapes). Treatment efficiency was evaluated by measuring optimization time, delivery time, and total time (optimization+delivery). Plan quality was assessed by evaluating organ at risk sparing. Ten patient plans were measured using a modified linac control system to assess delivery accuracy via a gamma analysis (2%/2 mm). Delivery efficiency was calculated as average dose rate divided by maximum dose rate.

Results: For Hyp-VMAT and OFL+PGD-VMAT, the total time was reduced by 124 ± 140 seconds (P = .020) and 459 ± 110 seconds (P < .001), respectively, as compared with the clinical Hyp-IMRT group. Speed enhancements were also measured for adapt-to-position with reductions in total time of 404 ± 55 (P < .001) for VMAT-Weights as compared with the clinical IMRT-Shapes group. Bladder and rectum dosimetric volume histogram (DVH) points were within 1.3% or 0.8 cc for each group. All VMAT plans had gamma passing rates greater than 96%. The delivery efficiency of VMAT plans was 89.7 ± 2.7 % compared with 50.0 ± 2.2 % for clinical IMRT.

Conclusions: Incorporating VMAT into MRIgART will significantly reduce treatment session times while maintaining equivalent plan quality.

提高 MR-Linac 的传输效率:使用 VMAT 对前列腺 SBRT 进行综合评估。
目的:治疗时间长是 MRIgART 的一个限制因素。这项工作旨在通过引入 VMAT 的专用优化和投射技术,大幅提高 MR-linac 上的投射效率。将 MRIgART 期间的 VMAT 计划和传输质量与用于前列腺 SBRT 的分步射频 IMRT 进行比较:对之前在 1.5T MR-linac 上治疗过的 10 名前列腺患者进行回顾性重新计划,使用步进射频 IMRT 和摩纳哥的临床 Hyperion 优化器(Hyp-IMRT)、带有 VMAT 技术的同一优化器(Hyp-VMAT)以及带有 VMAT 的研究型优化器(OFL+PGD-VMAT),在五个分段中达到 36.25 Gy。然后使用两种不同的优化策略将这些计划调整到每个日常 MRI 数据集上,以评估 ATP 工作流程:"优化权重"(IMRT-权重和 VMAT-权重)和 "优化形状"(IMRT-形状和 VMAT-形状)。通过测量优化时间、传输时间和总时间(优化 + 传输)来评估治疗效率。计划质量通过评估 OAR 疏通情况进行评估。通过伽马分析(2%/2mm),使用改良的直列加速器控制系统测量了十个病人的计划,以评估投放准确性。输送效率的计算方法是平均剂量率除以最大剂量率:结果:与临床Hyp-IMRT组相比,Hyp-VMAT和OFL+PGD-VMAT的总时间分别缩短了124±140秒(p = .020)和459±110秒(p < 0.001)。ATP 的速度也得到了提高,总时间减少了 404 ± 55 秒(p 结论:将 VMAT 纳入 MRIgART 将显著缩短治疗时间,同时保持同等的计划质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
11.00
自引率
7.10%
发文量
2538
审稿时长
6.6 weeks
期刊介绍: International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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