The Potential to Deliver a Simultaneous Integrated Boost to the Definite Target Volume Without Compromising OAR Doses

e15505 Background: Based on dosimetry and radiobiology to compare treatment plans for esophageal cancer (EC) in different location using intensity modulated radiotherapy (IMRT), volumetric modulated arc radiotherapy (VMAT) and helical tomotherapy(HT) with simultaneous integrated boost (SIB) technique. Methods: A total of 20 patients including 5 cases respectively located in the cervix, upper, middle and lower thorax were generated for IMRT, VMAT and HT plans. The dose volume histogram statistics, conformity index (CI), homogeneity index (HI), tumor control probability (TCP) and normal tissues control probability (NTCP) were analyzed to evaluate treatment plans. Results: HT showed significantly improvement over IMRT and VMAT in terms of CI(0.93±0.03), HI(0.07±0.03) and TCP(88.08±0.82%) in cervical EC(p<0.05). IMRT greatly developed TCP(88.29±1.79%;85.11±0.79%), and offered superior CIs (0.87±0.04;0.90±0.01) and HIs(0.10±0.01; 0.06±0.01) compared with VMAT and HT in upper and middle thoracic EC(p<0.05). Meanwhile, the V30(33.30±6.49%), mean dose (2559.00±219.64cGy) and NTCP(0.50±0.61%) of heart for IMRT were significantly reduced than other two techniques in middle thoracic EC. Patients with lower thoracic EC yielded the similar CIs and HIs(all p>0.05) for the 3 techniques, but VMAT showed the lowest NTCP of lungs (0.01±0.01%) with improved TCP (84.84±1.13%). Conclusions: HT was a good option with little lung and heart involvement as it achieved superior dose conformality and uniformity. IMRT was a perfect strategy with large thoracic involvement. It significantly improved tumor local control and reduced heart dose and complications with acceptable dose to lungs. VMAT was preferred with a smaller target volume but surrounded by more heart and less lungs. Individually choosing optimal technique for EC in different location will be warranted.

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Hypofractionated Radiotherapy Using Simultaneous Integrated Boost Technique with Concurrent and Adjuvant Temozolomide for Glioblastoma

Journal of Cancer and Tumor International ◽

10.9734/jcti/2020/v10i430134 ◽

2020 ◽

pp. 16-23

Author(s):

Manal M. S. Elghareeb ◽

Hanan Ahmed Wahba ◽

Ahmed M. El- Demeri ◽

Mohamed Elashry ◽

Rasha Abd El Ghany Khedr

Keyword(s):

Performance Status ◽

Group Versus ◽

Target Volume ◽

Simultaneous Integrated Boost ◽

University Hospital ◽

Hypofractionated Radiotherapy ◽

Conventional Radiotherapy ◽

Integrated Boost ◽

A Prospective Study ◽

To Receive

Aim: This study was conducted to assess the safety and efficacy of postoperative hypofractionated radiotherapy (HRT) using simultaneous integrated boost (SIB) technique for glioblastoma (GBM) compared to conventional radiotherapy (CRT). Study Design: This was a prospective study with historical control arm. Place and Duration of the Study: Department of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Mansoura, Egypt, between May 2017 and June 2019. Methods: The intervention (HRT) group included 30 patients who received 3D conformal HRT with SIB using field in field (FIF) technique to deliver a differential radiation dose to different targets. Planning target volume 60 (PTV60) includes the gross target volume (GTV) plus a 5-mm margin, and PTV45 includes the GTV plus a 15-mm margin. PTV60 will receive 60 Gy in 20 fractions, and PTV45 will receive 45 Gy in the same 20 fractions (one fraction daily and 5 days per week).The CRT group included 30 patients who received 3D conformal CRT with total dose 60 Gy in 2-Gy fractions delivered over 6 weeks. Both groups was planned to receive concurrent and adjuvant temozolamide. Results: The median PFS was 10 months in both groups. The median OS was 13 months in HRT group versus 12 months in CRT group which is statistically non significant. The toxicities were mild and acceptable. Performance status and adjuvant temozolamide were significant predictors that affect the overall survival. Conclusions: HRT with SIB using 3D conformal RTH with (FIF) technique in patients with GBM is a feasible and safe treatment and its results is comparable to the conventional radiotherapy.

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Dosimetric comparison of simultaneous integrated boost versus concomitant electron boost in radiotherapy treatment of breast cancer

Journal of Radiotherapy in Practice ◽

10.1017/s1460396917000127 ◽

2017 ◽

Vol 16 (3) ◽

pp. 334-341 ◽

Cited By ~ 1

Author(s):

C. Y. Yuen ◽

W. L. Au ◽

W. L. Chan ◽

Y. T. Yiu ◽

Y. Y. Law ◽

...

Keyword(s):

Target Volume ◽

Simultaneous Integrated Boost ◽

Skin Dose ◽

Computed Tomographic ◽

Heart Dose ◽

Adequate Dose ◽

Sequential Boost ◽

Significant Difference ◽

Integrated Boost ◽

Electron Boost

AbstractBackgroundThe aim of this study was to compare the dosimetric parameters and effects of simultaneous integrated boost (SIB) and traditional sequential electron boost, after helical tomotherapy, because of the lack of studies in this field in the current literature.MethodsComputed tomographic data of 14 patients who received SIB in 2012–2015 were collected from Hong Kong Sanatorium & Hospital. New tomotherapy with SIB plans and tomotherapy with sequential boost plans were generated for each patient, and results were compared.ResultsConformation number, mean dose, dose received by 95% volume (both sides), ipsilateral lung volume receiving 20 Gy (V20) and skin dose (right side) were found to be significantly better for SIB (p<0·05), however coverage index and gross target volume dose showed no significant difference, and heart dose was significantly higher for SIB on the right side.ConclusionTomotherapy with SIB may be able to offer less organ at risk dose (except for the heart), while maintaining the ability to deliver adequate dose coverage.

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Intensity-modulated salvage radiotherapy with simultaneous integrated boost for local recurrence of prostate carcinoma: a pilot study on the place of PET-choline for guiding target volume delineation

British Journal of Radiology ◽

10.1259/bjr.20150579 ◽

2016 ◽

Vol 89 (1058) ◽

pp. 20150579 ◽

Cited By ~ 5

Author(s):

Aurélien Wahart ◽

Jean-Baptiste Guy ◽

Alexis Vallard ◽

Benjamin Geissler ◽

Majed Ben Mrad ◽

...

Keyword(s):

Pilot Study ◽

Local Recurrence ◽

Prostate Carcinoma ◽

Target Volume ◽

Salvage Radiotherapy ◽

Simultaneous Integrated Boost ◽

Target Volume Delineation ◽

Intensity Modulated ◽

Volume Delineation ◽

Integrated Boost

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Simultaneous integrated boost by intensity modulated radiation therapy in carcinoma left breast after breast conservation surgery -A preliminary experience

International Journal of Applied Sciences and Biotechnology ◽

10.3126/ijasbt.v1i4.8794 ◽

2013 ◽

Vol 1 (4) ◽

pp. 197-201

Author(s):

Rashi Agrawal ◽

Dinesh Singh

Keyword(s):

Clinical Target Volume ◽

Treatment Time ◽

Breast Conservation ◽

Target Volume ◽

Left Breast ◽

Simultaneous Integrated Boost ◽

Breast Conservation Surgery ◽

Conservation Surgery ◽

Integrated Boost

Aim of study-Breast conservation surgery followed by radiotherapy has become the standard of care for early breast cancer. Total treatment time extends from6½ to 7 weeks. In radiotherapy such a long treatment duration is always worrisome. Simultaneous treatment of cavity and breast can reduce treatment time but we should consider acute and late toxicities. Materials and methods- In this study we are presenting data of 14consecutive patients of carcinoma left breast which were treated between March 2010 and June 2012.Dose prescribed to clinical target volume breast was 50 Gy in 25 fractions and CTV boost was 60 Gy in 25 fractions. Results-Clinical target volume for cavity ranged from 34.81cc to 369.8cc. Two patients (14.2%) had acute grade 2 skin toxicity and all other (85.7%) grade 1. Higher dose in boost region did not produce differential fibrosis or edema of breast. Median follow up is 26 months. None of our patients has experienced cardiac or pulmonary toxicity till date and all are in regular follow up. Conclusion-With simultaneous integrated boost in carcinoma breast patients, overall treatment time can be reduced without increasing early and late toxicities. Accrual of more patients is continuing. DOI: http://dx.doi.org/10.3126/ijasbt.v1i4.8794 Int J Appl Sci Biotechnol, Vol. 1(4): 197-201

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Breast boost vector: a new metric proposed to optimise isocentre location in an fIMRT–VMAT hybrid technique for a simultaneous integrated boost in breast radiotherapy

Journal of Radiotherapy in Practice ◽

10.1017/s1460396920000242 ◽

2020 ◽

pp. 1-6

Author(s):

Víctor de la Llana ◽

Ángel del Castillo ◽

Carlos Andrés ◽

Laura Gómez ◽

Manuel Agulla ◽

...

Keyword(s):

Organs At Risk ◽

Volumetric Modulated Arc Therapy ◽

Intensity Modulated Radiation Therapy ◽

Target Volume ◽

Simultaneous Integrated Boost ◽

Hybrid Technique ◽

Breast Radiotherapy ◽

Breast Cancer Radiotherapy ◽

Integrated Boost ◽

The Mean

Abstract Purpose: Evaluating the improvements of placing the treatment isocentre at the boost centre of mass (CoM) in a hybrid treatment for breast cancer radiotherapy. Material and methods: Twenty-two patients were planned in two isocentre locations with two forward intensity-modulated radiation therapy (fIMRT) tangentials to the breast and a volumetric-modulated arc therapy (VMAT) to the boost. A simultaneous integrated boost technique was used. Breast Boost (BB) Vector was investigated as a criterion for selecting an appropriate isocentre placement. Various metrics for boost, breast and hybrid plans were analysed using analysis of variance statistics. Results: Comparing hybrid plans at the boost CoM vs. hybrid plans at the breast CoM, no significant differences were found. Analysis of relative variations of planning target volume (PTV) boost coverage vs. BB Vector indicated an upgrade in boost CoM isocentre strategy. Dose to organs at risk was comparable: V5Gy (26·24 vs. 25·69%, p = 0·8), V20Gy (14·66 vs. 14·58%, p = 0·959) and the mean dose (7·37 Gy vs. 7·26 Gy, p = 0·879) to ipsilateral lung; V5Gy (15·60 vs. 15·22%, p = 0·903), and the mean dose (4·91 Gy vs. 4·86 Gy, p = 0·950) to heart and dose to free breast of boost (46·71 Gy vs. 46·62 Gy, p = 0·408). Findings: The hybrid fIMRT–VMAT technique centred at the boost CoM resulted equivalent to plans centred at the breast CoM, while benefiting from an enhancement in PTV boost coverage for patients with BB Vector superior to 5.

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Simultaneous Integrated Boost Intensity-Modulated Radiotherapy for Locally Advanced Drug-Resistant Gastrointestinal Stromal Tumors: A Feasibility Study

Frontiers in Oncology ◽

10.3389/fonc.2020.545892 ◽

2020 ◽

Vol 10 ◽

Author(s):

Longhao Li ◽

Xin Yi ◽

Haixia Cui ◽

Xuemei Zhao ◽

Jun Dang ◽

...

Keyword(s):

Tumor Size ◽

Gastrointestinal Stromal Tumors ◽

Locally Advanced ◽

Target Volume ◽

Simultaneous Integrated Boost ◽

Drug Resistant ◽

Stromal Tumors ◽

Intensity Modulated ◽

Significant Difference ◽

Integrated Boost

BackgroundAs an emerging clinical problem, locally advanced drug-resistant gastrointestinal stromal tumors (LADRGISTs) has relatively few therapeutic schemes. Although radiotherapy is not often considered for GISTs, it could be a valuable contributing modality. The aim of our study is to explore a safe and effective radiation regimen for LADR-GISTs.MethodsThree patients with LADR-GISTs were treated with simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) plans. In the SIB-IMRT plans, gross target volume (GTV) was divided into GTV-outer, GTV-mid, and GTV-center. And the prescribed dose of planning gross target volume (PGTV) and GTV-outer were both set to 50.4 Gy in 28 fractions. GTV-mid and GTV-center were simultaneously boosted to 60–62 Gy and 62–64 Gy respectively. For comparison purposes, conventional IMRT (Con-IMRT) plans with uniform dose distribution were generated for same optimization objectives without a dose boost to GTV-mid and GTV-center. All plans were optimized to make sure that deliver at least 95% of the prescription dose was delivered to PGTV. Isodose distribution, dose profiles, conformity indexes (CIs), monitor units (MUs), and dose volume histogram (DVH) was evaluated for each individual patient. After the three patients were treated with SIB-IMRT plans, the relative changes in the tumor size and CT values by CT scanning were also tracked.ResultsCompared with Con-IMRT plans, SIB-IMRT plans saw a significant increase from D95 to D2 of the GTV. With steeper dose gradients in the dose profiles, SIB-IMRT plans had GTV-mid and GTV-center accumulated with higher dose mainly by delivering extra 93 MUs in average. However, there was no significant difference in CIs and organs at risks (OARs) DVH. The relative changes in tumor size and CT values of the three patients in follow up were up to the Choi criteria and the three patients were all assessed as partial response.ConclusionsThe proposed SIB-IMRT may be a potential technique for achieving objective response and prolonging survival of selected GISTs patients.

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