Plan robustness of craniospinal irradiation with VMAT

Jian Xu, Qiang Wang, Keqiang Wang, Huipeng Meng, Hua-jiang Dong
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Abstract

Objective To compare the dosimetric characteristics of the methods of volumetric modulated arc therapy (VMAT) for craniospinal irradiation, and to compare their robustness to the field placement error. Methods Six patients receiving craniospinal irradiation were included. VMAT plans of each patient were optimized with overlap method and gradient-optimization method respectively using Pinnacle 9.8 VMAT treatment planning system. The length of the overlap region was set as 3 and 9 cm, respectively. Then the dose distributions under different VMAT programs were measured. Moreover, a 3 mm placement error was introduced, and the dose cold spot in the field junction region obtained by each plan was compared for robustness analysis. Results Under different overlapping lengths, the overlap method and the gradient optimization method both can optimize the VMAT plan that meeting the clinical requirements. In the field junction region, the dose distribution obtained by the overlap method was more uniform, and the difference in the uniformity index was statistically significant. When introducing a 3 mm placement error, the gradient optimization method obtained the most robust VMAT plan at 9 cm overlap length, and the overlap method could not obtained stabilized robust plan. Conclusions For the optimization of craniospinal irradiation VMAT plan, the commonly used overlap method can obtain a better dose distribution, but it can't improve robustness by increasing overlap length. However, using the gradient optimization method, the dose homogeneity in the field junction region is not good as the overlap method, but the plan robustness can be improved by increasing the overlap length. Key words: Craniospinal irradiation; Volumetric modulated arc therapy; Robustness; Overlap gradient-optimization
计划VMAT对颅脊髓照射的稳健性
目的比较体积调制弧线治疗(VMAT)方法的剂量学特性,并比较其对场位误差的稳健性。方法对6例接受颅脊髓放射治疗的患者进行分析。采用Pinnacle 9.8 VMAT治疗计划系统,分别采用重叠法和梯度优化法对每位患者的VMAT计划进行优化。设置重叠区域的长度分别为3 cm和9 cm。然后测量不同VMAT方案下的剂量分布。此外,引入了3 mm的放置误差,并比较了各方案在现场接点区域获得的剂量冷点,进行鲁棒性分析。结果在不同重叠长度下,重叠法和梯度优化法均能优化出符合临床要求的VMAT方案。在场结区,重叠法得到的剂量分布更为均匀,均匀性指数差异有统计学意义。当引入3 mm的放置误差时,梯度优化方法在重叠长度为9 cm时获得了最稳健的VMAT方案,重叠方法无法获得稳定的稳健方案。结论优选颅脊柱辐照VMAT计划时,常用的重叠法可获得较好的剂量分布,但不能通过增加重叠长度来提高稳健性。然而,梯度优化方法在场结区的剂量均匀性不如重叠法好,但可以通过增加重叠长度来提高计划鲁棒性。关键词:颅脊髓照射;体积调制电弧疗法;鲁棒性;重叠梯度优化
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