Improving Lung Stereotactic Body Radiation Therapy Dose Conformity Using a Simple Noncoplanar Volumetric Modulated Arc Therapy Technique.

IF 3.4 3区 医学 Q2 ONCOLOGY
Tiffany Kei, Kirk Luca, Oluwatosin Kayode, Kristin A Higgins, Jeffrey D Bradley, Joseph W Shelton, Ashish B Patel, Xiaofeng Yang, Eduard Schreibmann, Jiahan Zhang, Aparna H Kesarwala, Justin Roper
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Abstract

This study characterizes lung stereotactic body radiation therapy (SBRT) dose conformity for a noncoplanar volumetric modulated arc therapy (VMAT) technique. Retrospectively, 288 previously treated lung SBRT cases were replanned using a VMAT technique of 2 ipsilateral 180° arcs separated by 30° couch angles. Two objectives were used for optimization: a lower objective to achieve planning target volume (PTV) coverage and a custom normal tissue objective to steepen the dose gradient. The dose was calculated using Acuros. PTV coverage was 95%. Doses to the spinal cord, chest wall, esophagus, great vessels, heart, lungs, and trachea were evaluated. Conformity index (CI, isodose volume/PTV) values were recorded at the 10% to 100% isodose levels. CI50% results were benchmarked against the corresponding clinical plans and evaluated using the Wilcoxon signed-rank test. Linear regression was performed to characterize the relationship between dose conformity and the following PTV features: Hounsfield Units, volume, surface area, surface-to-volume ratio, and compactness. Compared with the clinical plans, the 2-objective VMAT plans demonstrated comparable or superior sparing of organs at risk with improvements in CI at the 10% to 100% isodose levels, all of which were statistically significant (P < .001). The average reductions in CI30% and CI50% were 3.5 and 0.63, respectively. Compared with the clinical plans, cases exceeding Radiation Therapy Oncology Group CI50% limits were reduced from n = 10 to 0 unacceptable and n = 78 to 20 acceptable variations. At CI30% to CI60%, regression showed that PTV Hounsfield Units and surface-to-volume ratio were significant (P < .001) predictors of dose conformity. An easily implementable VMAT technique achieved improved conformity across a broad range of lung SBRT cases and is now the standard at our institution. Further, dose conformity was characterized at different isodose levels with consideration of PTV features. Results from this study supplement historic clinical trial guidelines by providing more comprehensive and patient-specific goals for lung SBRT dose conformity.

使用简单的非平面 VMAT 技术改善肺部 SBRT 剂量一致性。
目的:本研究表征非共面VMAT技术的肺SBRT剂量符合性。方法:回顾性分析288例既往治疗的肺SBRT病例,采用VMAT技术将两个同侧180°的弧线以30°的卧角分开。两个物镜用于优化:一个较低的物镜用于实现PTV覆盖,一个自定义的NTO用于陡峭剂量梯度。使用acros计算剂量。PTV覆盖率达95%。评估了对脊髓、胸壁、食道、大血管、心脏、肺和气管的剂量。在10%至100%等剂量水平下记录合格指数(CI=等剂量体积/PTV)值。CI50%的结果以相应的临床计划为基准,并使用Wilcoxon sign -rank检验进行评估。采用线性回归表征剂量一致性与以下PTV特征之间的关系:HUs、体积、表面积、表面体积比和致密性。结果:与临床方案相比,双目标VMAT方案显示出相当或更好的OARs节约,在10%至100%等剂量水平下CI改善,所有这些都具有统计学意义(p结论:易于实施的VMAT技术在广泛的肺SBRT病例中提高了符合性,现在是我们机构的标准。此外,考虑到PTV特征,在不同等剂量水平下对剂量一致性进行了表征。本研究的结果补充了历史上的临床试验指南,为肺部SBRT剂量一致性提供了更全面和患者特异性的目标。
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
Practical Radiation Oncology
Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
5.20
自引率
6.10%
发文量
177
审稿时长
34 days
期刊介绍: The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.
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