Analysis of normal lung irradiation in radiosurgery treatments: a comparison of lung optimized treatment (LOT) on cyberknife, 4D target volume on helical tomotherapy, and DIBH on linear accelerator

2021 ◽  
Author(s):  
Raghavendra Holla ◽  
D. Khanna ◽  
V. K. Sathiya Narayanan ◽  
Deb Narayan Dutta
Keyword(s):  
Linear Accelerator ◽  
Helical Tomotherapy ◽  
Target Volume ◽  
Normal Lung ◽  
Lung Irradiation ◽  
Optimized Treatment

Dosimetric comparison of fractionated radiosurgery plans using frameless Gamma Knife ICON and CyberKnife systems with linear accelerator–based radiosurgery plans for multiple large brain metastases

2020 ◽  
Vol 132 (5) ◽  
pp. 1473-1479 ◽  
Author(s):  
Eun Young Han ◽  
He Wang ◽  
Dershan Luo ◽  
Jing Li ◽  
Xin Wang
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Linear Accelerator ◽  
Treatment Time ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Normal Brain ◽  
Large Brain ◽  
The Mean

OBJECTIVEFor patients with multiple large brain metastases with at least 1 target volume larger than 10 cm3, multifractionated stereotactic radiosurgery (MF-SRS) has commonly been delivered with a linear accelerator (LINAC). Recent advances of Gamma Knife (GK) units with kilovolt cone-beam CT and CyberKnife (CK) units with multileaf collimators also make them attractive choices. The purpose of this study was to compare the dosimetry of MF-SRS plans deliverable on GK, CK, and LINAC and to discuss related clinical issues.METHODSTen patients with 2 or more large brain metastases who had been treated with MF-SRS on LINAC were identified. The median planning target volume was 18.31 cm3 (mean 21.31 cm3, range 3.42–49.97 cm3), and the median prescribed dose was 27.0 Gy (mean 26.7 Gy, range 21–30 Gy), administered in 3 to 5 fractions. Clinical LINAC treatment plans were generated using inverse planning with intensity modulation on a Pinnacle treatment planning system (version 9.10) for the Varian TrueBeam STx system. GK and CK planning were retrospectively performed using Leksell GammaPlan version 10.1 and Accuray Precision version 1.1.0.0 for the CK M6 system. Tumor coverage, Paddick conformity index (CI), gradient index (GI), and normal brain tissue receiving 4, 12, and 20 Gy were used to compare plan quality. Net beam-on time and approximate planning time were also collected for all cases.RESULTSPlans from all 3 modalities satisfied clinical requirements in target coverage and normal tissue sparing. The mean CI was comparable (0.79, 0.78, and 0.76) for the GK, CK, and LINAC plans. The mean GI was 3.1 for both the GK and the CK plans, whereas the mean GI of the LINAC plans was 4.1. The lower GI of the GK and CK plans would have resulted in significantly lower normal brain volumes receiving a medium or high dose. On average, GK and CK plans spared the normal brain volume receiving at least 12 Gy and 20 Gy by approximately 20% in comparison with the LINAC plans. However, the mean beam-on time of GK (∼ 64 minutes assuming a dose rate of 2.5 Gy/minute) plans was significantly longer than that of CK (∼ 31 minutes) or LINAC (∼ 4 minutes) plans.CONCLUSIONSAll 3 modalities are capable of treating multiple large brain lesions with MF-SRS. GK has the most flexible workflow and excellent dosimetry, but could be limited by the treatment time. CK has dosimetry comparable to that of GK with a consistent treatment time of approximately 30 minutes. LINAC has a much shorter treatment time, but residual rotational error could be a concern.

Linac Based Total Marrow Irradiation and Myeloablative Chemotherapy In Allogeneic Stem Cell Transplantation for High Risk Patients.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4526-4526
Author(s):  
Pritesh R. Patel ◽  
Bulent Aydogan ◽  
Damiano Rondelli
Keyword(s):  
Linear Accelerator ◽  
Treatment Time ◽  
Conflicts Of Interest ◽  
Organs At Risk ◽  
Chronic Gvhd ◽  
Ct Scanning ◽  
Test Dose ◽  
Target Volume ◽  
Whole Body ◽  
Total Marrow Irradiation

Abstract Abstract 4526 Intensity modulated total marrow irradiation (IM-TMI) represents an innovative technique to irradiate the bone marrow in hematologic malignancies. IM-TMI has been performed previously using tomotherapy in combination with a reduced intensity preparative regimen. Here we report 2 cases where IM-TMI 300cGy was delivered using a linear accelerator in combination with fludarabine/IV busulfan. To plan IM-TMI, 5 mm-slice CT scanning from top of the head to the mid femur was performed with immobilization using a customized whole body alpha cradle. All bones (excluding the arms and lower extremities) were contoured as the clinical target volume. A 3 mm margin was added to obtain the planning target volume (PTV). The organs at risk (OAR) including the brain, lenses, lungs, liver, kidney, small bowel and heart were identified and contoured. The IM-TMI technique consisted of three separate treatment plans: the head and neck; trunk; and pelvis. Patients received fludarabine 40mg/m2 on days -8 to -5. IV busulfan was given on days -5 to -2 targeting an AUC of 4800microM/min based on a pretransplant test dose. IM-TMI was delivered on day -5. The patients received a total of 300 cGy IM-TMI dose in two fractions, 8 hours apart. Two patients were treated: one is a 63 year old male with multiple myeloma who relapsed within 6 months after an autologous transplant with new cytogenetic abnormalities; and the second is a 52 years old female with AML who failed initial induction chemotherapy and at the time of transplant was in complete remission after receiving a second induction and one consolidation chemotherapy. Both patients received PBSC from HLA matched siblings. IM-TMI technique achieved 95% coverage of the PTV. The mean doses to the lenses and lungs were 99 and 195 cGy, respectively. Overall doses delivered to OAR were reduced by 20–67% on average when compared to standard total body irradiation. Treatment time was 44 min and 32 min for the beam-on and set-up, respectively, using the Varian 21 EX linac and MV imaging. Both patients suffered Bearman grade 1 mucositis. No other extramedullary toxicities were observed. Both engrafted in a timely manner achieving neutrophil >0.5 × 109/L at day 13 and 14, and platelet >20 × 109/L at day 8 and 9, respectively. Full donor chimerism was noted by day +30. After follow up of 246 and 218 days, respectively, both patients are alive and in remission. One developed a grade 2 acute GVHD and none of them has chronic GVHD. This study demonstrates for the first time the use of IM-TMI using a linear accelerator. The possibility of adding higher doses of IM-TMI to a myeloablative regimen without toxicity will be tested in a dose escalating clinical trial. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Short-term efficacy comparison between helical tomotherapy and intensity-modulated radiotherapy in patients with locally advanced nasopharyngeal carcinoma

2020 ◽  
Author(s):  
Zhen Cui ◽  
Jia Liu ◽  
Qiaoyu Sun ◽  
Chaoge Wang ◽  
Meifang Fang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Planning Target Volume ◽  
Helical Tomotherapy ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Target Volume ◽  
Short Term ◽  
Intensity Modulated ◽  
Significant Difference ◽  
Better Than

Abstract Background: To evaluate short-term safety and efficacy of helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC).Methods: Retrospective analysis of locally advanced nasopharyngeal carcinoma treated with radiotherapy and concurrent platinum based neoadjuvant chemotherapy (cisplatin 80 mg/m2 every 3 weeks for 1 cycle) in our hospital from February 2017 to October 2019, including 70 patients in HT group and 70 in IMRT group. The target area of ​​the tumor was delineated by magnetic resonance (MRI) imaging. The prescription doses delivered to the gross tumor volume (pGTVnx) and positive lymph nodes (pGTVnd), the high risk planning target volume (PTV1), and the low risk planning target volume (PTV2), were 69.96 Gy, 66-70 Gy, 60 Gy and 50-54 Gy, in 33 fractions, respectively. Acute reactions were evaluated according to the RTOG/EORTC criteria, whereas the therapeutic efficacy was assessed according to RECTST version 1.1 criteria in a 3-months period.Results: The CI of PGTVnx, PGTVnd, PTV1 and PTV2, and HI of PGTVnx, PTV1 and PTV2 in HT group was significantly better than those in IMRT group. The OAR Dmax and Dmean in HT group were better than those in IMRT group with a significant difference (all p <0.05). Patients in the HT group were significantly better than those in the IMRT group in the protection of acute parotid gland injury and hearing damage (p <0.05), but not other acute adverse reaction. No significant difference was found on the short-term efficacy illustrated by ORR between HT group and IMRT group (x2 = 0.119; p = 0.730).Conclusions: Compared with IMRT, HT has better radiophysical-related dosimetric advantages in radiotherapy for locally advanced nasopharyngeal carcinoma. Despite similar on short-term effects, HT has lower incidence of adverse reactions than IMRT.

ARDS in the setting of FOLFOX/cetuximab based chemoradiotherapy for locally advanced esophageal adenocarcinoma (E2205).

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 121-121
Author(s):  
Ramla NAMISANGO Kasozi ◽  
Anita Choudhary ◽  
Michael K. Gibson ◽  
Paul J. Catalano ◽  
Lawrence Kleinberg ◽  
...  
Keyword(s):  
Potential Role ◽  
Distress Syndrome ◽  
Locally Advanced ◽  
Growth Factor Receptor ◽  
Target Volume ◽  
Normal Lung ◽  
Radiation Technique ◽  
Epidermal Growth ◽  
Clinical Trial Information

121 Background: E2205 was a single-arm, phase II trial that added an epidermal growth factor receptor (EGF-R) inhibitor, cetuximab (C), to CRT. The trial was closed early due to pulmonary toxicity. We investigated the potential role of cetuximab and type of radiation (IMRT vs conventional). Methods: Patients were treated with CRT: Oxaliplatin (OX) 85mg/m2 days 1,15,29; infusional 5-fluorouracil (5-FU) 180mg/m2/24hours x 35 days; C 400mg/m2 day 1 then 250mg/m2days 8,15,22,29 and radiation (IMRT allowed) 180cGy/day x 25 fractions (Monday-Friday), followed by esophagectomy. Results: Of 21 eligible patients enrolled, 17 had surgery (died pulmonary embolism 4 days after CRT, died G3 diarrhea/PD during CRT, died sepsis/hypoxia during CRT). pCR = 7/17. Four post-op deaths from acute respiratory distress syndrome (ARDS) resulted in 7 total study-related deaths. None of the patients who received IMRT died (0/3). 1/6 had ARDS if more than 4 fields with conventional or 3D planning was used. 3 of 15 treated with RT that met the criteria of E1201 guidelines (no more than 3-4 RT fields, normal lung more than 2 cm outside the target volume < 40 Gy, no IMRT). Overall, there was no demonstrable association of ARDS to radiation technique: 4/22 overall, 0/3 if IMRT was used. Conclusions: This regimen is not recommended. There is no clear association between use of IMRT and ARDS. The cause of ARDS remains undetermined. Cetuximab may have played a role. Clinical trial information: NCT00551759.

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