Feasibility study of volumetric modulated arc therapy with Halcyon™ linac for total body irradiation

Abstract Background The use of total body irradiation (TBI) with linac-based volumetric modulated arc therapy (VMAT) has been steadily increasing. Helical tomotherapy has been applied in TBI and total marrow irradiation to reduce the dose to critical organs, especially the lungs. However, the methodology of TBI with Halcyon™ linac remains unclear. This study aimed to evaluate whether VMAT with Halcyon™ linac can be clinically used for TBI. Methods VMAT planning with Halcyon™ linac was conducted using a whole-body computed tomography data set. The planning target volume (PTV) included the body cropped 3 mm from the source. A dose of 12 Gy in six fractions was prescribed for 50% of the PTV. The organs at risk (OARs) included the lens, lungs, kidneys, and testes. Results The PTV D98%, D95%, D50%, and D2% were 8.9 (74.2%), 10.1 (84.2%), 12.6 (105%), and 14.2 Gy (118%), respectively. The homogeneity index was 0.42. For OARs, the Dmean of the lungs, kidneys, lens, and testes were 9.6, 8.5, 8.9, and 4.4 Gy, respectively. The V12Gy of the lungs and kidneys were 4.5% and 0%, respectively. The Dmax of the testes was 5.8 Gy. Contouring took 1–2 h. Dose calculation and optimization was performed for 3–4 h. Quality assurance (QA) took 2–3 h. The treatment duration was 23 min. Conclusions A planning study of TBI with Halcyon™ to set up VMAT-TBI, dosimetric evaluation, and pretreatment QA, was established.

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Optimized Conformal Total Body Irradiation Among Recipients of TCRαβ/CD19-Depleted Grafts in Pediatric Patients With Hematologic Malignancies: Single-Center Experience

Frontiers in Oncology ◽

10.3389/fonc.2021.785916 ◽

2021 ◽

Vol 11 ◽

Author(s):

Daria Kobyzeva ◽

Larisa Shelikhova ◽

Anna Loginova ◽

Francheska Kanestri ◽

Diana Tovmasyan ◽

...

Keyword(s):

At Risk ◽

Radiation Therapy ◽

Dose Reduction ◽

Total Body Irradiation ◽

Pediatric Patients ◽

Organs At Risk ◽

Volumetric Modulated Arc Therapy ◽

Arc Therapy ◽

Total Body

Total body irradiation (TBI) in combination with chemotherapy is widely used as a conditioning regimen in pediatric and adult hematopoietic stem cell transplantation (HSCT). The combination of TBI with chemotherapy has demonstrated superior survival outcomes in patients with acute lymphoblastic and myeloid leukemia when compared with conditioning regimens based only on chemotherapy. The clinical application of intensity-modulated radiation therapy (IMRT)-based methods (volumetric modulated arc therapy (VMAT) and TomoTherapy) seems to be promising and has been actively used worldwide. The optimized conformal total body irradiation (OC-TBI) method described in this study provides selected dose reduction for organs at risk with respect to the most significant toxicity (lungs, kidneys, lenses). This study included 220 pediatric patients who received OC-TBI with subsequent chemotherapy and allogenic HSCT with TCRαβ/CD19 depletion. A group of 151 patients received OC-TBI using TomoTherapy, and 40 patients received OC-TBI using the Elekta Synergy™ linac with an Agility-MLC (Elekta, Crawley, UK) using volumetric modulated arc therapy (VMAT). Twenty-nine patients received OC-TBI with supplemental simultaneous boost to bone marrow—(SIB to BM) up to 15 Gy: 28 patients (pts)—TomoTherapy; one patient—VMAT. The follow-up duration ranged from 0.3 to 6.4 years (median follow-up, 2.8 years). Overall survival (OS) for all the patients was 63% (95% CI: 56–70), and event-free survival (EFS) was 58% (95% CI: 51–65). The cumulative incidence of transplant-related mortality (TRM) was 10.7% (95% CI: 2.2–16) for all patients. The incidence of early TRM (<100 days) was 5.0% (95% CI: 1.5–8.9), and that of late TRM (>100 days) was 5.7 (95% CI: 1.7–10.2). The main causes of death for all the patients were relapse and infection. The concept of OC-TBI using IMRT VMAT and helical treatment delivery on a TomoTherapy treatment unit provides maximum control of the dose distribution in extended targets with simultaneous dose reduction for organs at risk. This method demonstrated a low incidence of severe side effects after radiation therapy and predictable treatment effectiveness. Our initial experience demonstrates that OC-TBI appears to be a promising technique for the treatment of pediatric patients.

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Total-body irradiation using linac-based volumetric modulated arc therapy: Its clinical accuracy, feasibility and reliability

Radiotherapy and Oncology ◽

10.1016/j.radonc.2018.08.005 ◽

2018 ◽

Vol 129 (3) ◽

pp. 527-533 ◽

Cited By ~ 10

Author(s):

Bora Tas ◽

Ismail Faruk Durmus ◽

Ayse Okumus ◽

Omer Erol Uzel ◽

Muge Gokce ◽

...

Keyword(s):

Total Body Irradiation ◽

Volumetric Modulated Arc Therapy ◽

Arc Therapy ◽

Clinical Accuracy ◽

Total Body

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Volumetric Modulated Arc Therapy Based Total Body Irradiation – Five Year Clinical Experience

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.176 ◽

2020 ◽

Vol 108 (3) ◽

pp. e753

Author(s):

E.R. Zhang-Velten ◽

D.D.M. Parsons ◽

J. Tan ◽

M. Joo ◽

R.R. Reynolds ◽

...

Keyword(s):

Clinical Experience ◽

Total Body Irradiation ◽

Volumetric Modulated Arc Therapy ◽

Arc Therapy ◽

Total Body

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EP-1546: Dose planning of a total body irradiation with Volumetric Modulated Arc Therapy (VMAT)

Radiotherapy and Oncology ◽

10.1016/s0167-8140(15)31664-9 ◽

2014 ◽

Vol 111 ◽

pp. S182

Author(s):

A. Springer ◽

E. Winkler ◽

E. Putz ◽

A. Altenburger ◽

R. Gruber ◽

...

Keyword(s):

Total Body Irradiation ◽

Volumetric Modulated Arc Therapy ◽

Dose Planning ◽

Arc Therapy ◽

Total Body

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Volumetric Modulated Arc Therapy Enabled Total Body Irradiation (VMAT-TBI): Six-year Clinical Experience and Treatment Outcomes

Transplantation and Cellular Therapy ◽

10.1016/j.jtct.2021.10.020 ◽

2021 ◽

Author(s):

Elizabeth Ren Zhang-Velten ◽

David Parsons ◽

Pam Lee ◽

Eric Chambers ◽

Ramzi Abdulrahman ◽

...

Keyword(s):

Treatment Outcomes ◽

Clinical Experience ◽

Total Body Irradiation ◽

Volumetric Modulated Arc Therapy ◽

Arc Therapy ◽

Total Body

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Adequate target volume in total-body irradiation by intensity-modulated radiation therapy using helical tomotherapy: a simulation study

Journal of Radiation Research ◽

10.1093/jrr/rrw115 ◽

2016 ◽

Vol 58 (2) ◽

pp. 210-216 ◽

Cited By ~ 4

Author(s):

Ryosuke Takenaka ◽

Akihiro Haga ◽

Hideomi Yamashita ◽

Keiichi Nakagawa

Keyword(s):

Radiation Therapy ◽

Total Body Irradiation ◽

Intensity Modulated Radiation Therapy ◽

Target Volume ◽

The Body ◽

High Fluence ◽

Intensity Modulated ◽

Small Set ◽

Total Body ◽

Set Up

Abstract Recently, intensity-modulated radiation therapy (IMRT) has been used for total-body irradiation (TBI). Since the planning target volume (PTV) for TBI includes the surrounding air, a dose prescription to the PTV provides high fluence to the body surface. Thus with just a small set-up error, the body might be exposed to a high-fluence beam. This study aims to assess which target volume should be prescribed the dose, such as a clinical target volume (CTV) with a margin, or a CTV that excludes the surface area of the skin. Three treatment plans were created for each patient: the 5-mm clipped plan (Plan A), the 0-mm margin plan (Plan B) and the 5-mm margin plan (Plan C). The CTV was the whole body. PTVs were the CTV with the exception of 5 mm from the skin surface in Plan A, equal to the CTV in Plan B, and the CTV with a 5 mm margin in Plan C. The prescribed dose was 12 Gy in six fractions. To assess the influence of the set-up error, dose distributions were simulated on computed tomography (CT) images shifted 2 pixels (= 4.296 mm), 5 pixels (= 10.74 mm) and 10 pixels (= 21.48 mm) in the lateral direction from the original CT. With a set-up error of 10.74 mm, V110% was 8.8%, 11.1% and 23.3% in Plans A, B and C, respectively. The prescription to the PTV containing the surrounding air can be paradoxically vulnerable to a high-dose as a consequence of a small set-up error.

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Dosimetric Comparison of Helical Tomotherapy, Volumetric-Modulated Arc Therapy, and Intensity-Modulated Proton Therapy for Angiosarcoma of the Scalp

Technology in Cancer Research & Treatment ◽

10.1177/1533033820985866 ◽

2021 ◽

Vol 20 ◽

pp. 153303382098586

Author(s):

Tomoki Mizuno ◽

Natsuo Tomita ◽

Taiki Takaoka ◽

Masashi Tomida ◽

Hiroshi Fukuma ◽

...

Keyword(s):

Proton Therapy ◽

Helical Tomotherapy ◽

Organs At Risk ◽

Volumetric Modulated Arc Therapy ◽

Target Volume ◽

The Other ◽

Intensity Modulated Proton Therapy ◽

Intensity Modulated ◽

Arc Therapy ◽

Dose Constraint

Objective: We compared radiotherapy plans among helical tomotherapy (HT), volumetric-modulated arc therapy (VMAT), and intensity-modulated proton therapy (IMPT) for angiosarcoma of the scalp (AS). Methods: We conducted a planning study for 19 patients with AS. The clinical target volume (CTV) 1 and CTV2 were defined as the gross tumor volume with a specific margin and total scalp, respectively. For HT and VMAT, the planning target volume (PTV) 1 and PTV2 were defined as CTV1 and CTV2 with 0.5-cm margins, respectively. For IMPT, robust optimization was used instead of a CTV-PTV margin (i.e. CTV robust). The targets of the HT and VMAT plans were the PTV, whereas the IMPT plans targeted the CTV robust. In total, 70 Gy and 56 Gy were prescribed as the D95% (i.e. dose to 95% volume) of PTV1 (or CTV1 robust) and PTV2 (or CTV2 robust), respectively, using the simultaneous integrated boost (SIB) technique. Other constraint goals were also defined for the target and organs at risk (OAR). Results: All dose constraint parameters for the target and OAR met the goals within the acceptable ranges for the 3 techniques. The coverage of the targets replaced by D95% and D98% were almost equivalent among the 3 techniques. The homogeneity index of PTV1 or CTV1 robust was equivalent among the 3 techniques, whereas that of PTV2 or CTV2 robust was significantly higher in the IMPT plans than in the other plans. IMPT reduced the Dmean of the brain and hippocampus by 49% to 95%, and the Dmax of the spinal cord, brainstem, and optic pathway by 70% to 92% compared with the other techniques. Conclusion: The 3 techniques with SIB methods provided sufficient coverage and satisfactory homogeneity for the targets, but IMPT achieved the best OAR sparing.

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Volumetric modulated arc therapy: a dosimetric comparison with dynamic IMRT and step-and-shoot IMRT

Journal of Radiotherapy in Practice ◽

10.1017/s1460396919000815 ◽

2019 ◽

Vol 19 (4) ◽

pp. 393-398 ◽

Cited By ~ 1

Author(s):

Payal Raina ◽

Sudha Singh ◽

Rajanigandha Tudu ◽

Rashmi Singh ◽

Anup Kumar

Keyword(s):

Organs At Risk ◽

Volumetric Modulated Arc Therapy ◽

Intensity Modulated Radiation Therapy ◽

Target Volume ◽

Planning System ◽

Treatment Planning System ◽

Conformity Index ◽

Delivery Time ◽

Arc Therapy ◽

Step And Shoot

AbstractAim:The aim of this study was to compare volumetric modulated arc therapy (VMAT) with dynamic intensity-modulated radiation therapy (dIMRT) and step-and-shoot IMRT (ssIMRT) for different treatment sites.Materials and methods:Twelve patients were selected for the planning comparison study. This included three head and neck, three brain, three rectal and three cervical cancer patients. Total dose of 50 Gy was given for all the plans. Plans were done for Elekta synergy with Monaco treatment planning system. All plans were generated with 6 MV photons beam. Plan evaluation was based on the ability to meet the dose volume histogram, dose homogeneity index, conformity index and radiation delivery time, and monitor unit needs to deliver the prescribed dose.Results:The VMAT and dIMRT plans achieved the better conformity (CI98% = 0·965 ± 0·023) and (CI98% = 0·939 ± 0·01), respectively, while ssIMRT plans were slightly inferior (CI98% = 0·901 ± 0·038). The inhomogeneity in the planning target volume (PTV) was highest with ssIMRT with HI equal to 0·097 ± 0·015 when compared to VMAT with HI equal to 0·092 ± 0·0369 and 0·095 ± 0·023 with dIMRT. The integral dose is found to be inferior with VMAT 105·31 ± 53·6 (Gy L) when compared with dIMRT 110·75 ± 52·9 (Gy L) and ssIMRT 115 38 ± 55·1(Gy L). All the techniques respected the planning objective for all organs at risk. The delivery time per fraction for VMAT was much lower than dIMRT and ssIMRT.Findings:Our results indicate that dIMRT and VMAT provide better sparing of normal tissue, homogeneity and conformity than ssIMRT with reduced treatment delivery time.

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