VMAT Planning With Xe-CT Functional Images Enables Radiotherapy Planning With Consideration of Lung Function

2021 ◽  
Vol 1 (3) ◽  
pp. 193-200
Author(s):  
NOBUKO UTSUMI ◽  
TAKEO TAKAHASHI ◽  
SHOGO HATANAKA ◽  
MASATSUGU HARIU ◽  
MIO SAITO ◽  
...  
Keyword(s):  
Lung Function ◽  
Lung Volume ◽  
Irradiation Dose ◽  
Radiation Pneumonitis ◽  
Volumetric Modulated Arc Therapy ◽  
Chest Ct ◽  
Severe Adverse Event ◽  
Radiotherapy Planning ◽  
Functional Images ◽  
Arc Therapy

Background/Aim: The most severe adverse event of radiotherapy in lung cancer is radiation pneumonitis (RP). Some indices commonly used to prevent RP are evaluated based on the anatomical lung volume. The irradiation dose may be more accurately assessed by using functional lung volume. We evaluated the usefulness of computed tomography (CT) incorporating functional ventilation images acquired by the inhalation of xenon (Xe) gas (Xe-CT functional images). Patients and Methods: Two plans were created for twelve patients: volumetric modulated arc therapy (VMAT) planning using conventional chest CT images (anatomical plans) and VMAT planning using Xe-CT functional images (functional plans), and the dosimetric parameters were compared. Results: Compared to the anatomical plans, the functional plans had significantly reduced V20Gy in the high-functional lungs (p=0.005), but significant differences were not seen in the moderate-functional and low-functional lungs. Conclusion: The incorporation of Xe-CT functional images into VMAT plans enables radiotherapy planning with consideration of lung function.

scholarly journals Hybrid volumetric-modulated arc therapy for postoperative breast cancer including regional lymph nodes: the advantage of dosimetric data and safety of toxicities

2020 ◽  
Vol 61 (5) ◽  
pp. 747-754
Author(s):  
Yoshiko Doi ◽  
Minoru Nakao ◽  
Hideharu Miura ◽  
Shuichi Ozawa ◽  
Masahiro Kenjo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Irradiation Dose ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Conformity Index ◽  
Regional Lymph Nodes ◽  
Dosimetric Data ◽  
Arc Therapy

ABSTRACT To improve the homogeneity and conformity of the irradiation dose for postoperative breast cancer including regional lymph nodes, we planned Hybrid volumetric-modulated arc therapy (VMAT), which combines conventional tangential field mainly for the chest area and VMAT mainly for the supraclavicular area and marginal zone. In this study, we compared the dosimetric impact between traditional 3D conformal radiotherapy (3DCRT) and Hybrid VMAT and observed toxicities following Hybrid VMAT. A total of 70 patients indicated between October 2016 and December 2017 were included. The prescribed dose was 50 Gy/25 fractions. For the dosimetric impact, 3DCRT and Hybrid VMAT plans were compared in each patient with respect to the dosimetric parameters. Toxicities were followed using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up duration was 319 days. For the dosimetric impact, the homogeneity index (HI) and conformity index (CI) of PTV were significantly improved in the Hybrid VMAT plan compared with that in the 3DCRT plan (HI, 0.15 ± 0.07 in Hybrid VMAT vs 0.41 ± 0.19 in 3DCRT, P < 0.001; CI, 1.61 ± 0.44 in Hybrid VMAT vs 2.10 ± 0.56 in 3DCRT, P < 0.001). The mean irradiated ipsilateral lung dose was not significantly different in both plans (12.0 ± 2.4 Gy in Hybrid VMAT vs 11.8 ± 2.8 Gy in 3DCRT, P < 0.533). Regarding toxicity, there were no patients who developed ≥grade 3 acute toxicity and ≥grade 2 pneumonitis during the follow-up. Hybrid VMAT for postoperative breast cancer including regional lymph nodes was a reasonable technique that improved the homogeneity and conformity of the irradiation dose to the planning target volume while keeping the irradiation dose to organs at risk to a minimum.

Radiation Pneumonitis After Volumetric Modulated Arc Therapy for Non-small Cell Lung Cancer

2021 ◽  
Vol 41 (11) ◽  
pp. 5793-5802
Author(s):  
MASAYUKI FUJIWARA ◽  
HIROSHI DOI ◽  
MASATAKA IGETA ◽  
HITOMI SUZUKI ◽  
KAZUHIRO KITAJIMA ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Radiation Pneumonitis ◽  
Volumetric Modulated Arc Therapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Arc Therapy

Potential benefits of volumetric modulated arc therapy to reduce the incidence of ≥ grade 2 radiation pneumonitis in radiotherapy for locally advanced non-small cell lung cancer patients

2021 ◽  
Author(s):  
Nobuki Imano ◽  
Tomoki Kimura ◽  
Daisuke Kawahara ◽  
Riku Nishioka ◽  
Wataru Fukumoto ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Radiation Pneumonitis ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Conformal Radiation Therapy ◽  
Arc Therapy

Abstract Background The use of volumetric modulated arc therapy is gradually widespread for locally advanced non-small cell lung cancer. The purpose of this study was to identify the factors that caused ≥ grade 2 radiation pneumonitis and evaluate the impact of using volumetric modulated arc therapy on the incidence of ≥ grade 2 radiation pneumonitis by comparing three-dimensional conformal radiation therapy. Methods We retrospectively evaluated 124 patients who underwent radical radiotherapy for locally advanced non-small cell lung cancer in our institution between 2008 and 2019. The following variables were analysed to detect the factors that affected ≥ grade 2 radiation pneumonitis; age, sex, the presence of interstitial lung disease, pulmonary emphysema, tumour location, stage, PTV/lung volume, lung V20Gy, total dose, concurrent chemoradiotherapy, adjuvant immune checkpoint inhibitor, radiotherapy method. Radiation pneumonitis was evaluated using the common terminology criteria for adverse events (version 5.0). Results A total of 84 patients underwent three-dimensional conformal radiation therapy (3D-CRT group) and 40 patients underwent volumetric modulated arc therapy (VMAT group). The cumulative incidence of ≥ grade 2 radiation pneumonitis at 12 months was significantly lower in the VMAT group than in the 3D-CRT group (25% vs. 49.1%). The use of volumetric modulated arc therapy was a significant factor for ≥ grade 2 radiation pneumonitis (HR:0.32, 95% CI: 0.15–0.65, P = 0.0017) in addition to lung V20Gy (≥ 24%, HR:5.72 (95% CI: 2.87–11.4), P < 0.0001) and total dose (≥ 70 Gy, HR:2.64 (95% CI: 1.39–5.03), P = 0.0031) even after adjustment by multivariate analysis. Conclusions We identified factors associated with ≥ grade 2 radiation pneumonitis in radiotherapy for patients with locally advanced non-small cell lung cancer. Volumetric modulated arc therapy has potential benefits to reduce the risk of ≥ grade 2 radiation pneumonitis.

Simulation study of volumetric modulated arc therapy for thoracic esophageal cancer using automated-radiotherapy planning software.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 158-158
Author(s):  
Yuji Murakami ◽  
Yasushi Nagata ◽  
Tomoki Kimura ◽  
Ikuno Nishibuchi ◽  
Takeo Nakashima
Keyword(s):  
Esophageal Cancer ◽  
Left Ventricle ◽  
Simulation Study ◽  
Low Dose ◽  
Volumetric Modulated Arc Therapy ◽  
Radiotherapy Planning ◽  
High Dose ◽  
Planning Software ◽  
Arc Therapy ◽  
Left Pleura

158 Background: To prevent cardiac toxicity after chemoradiotherapy for esophageal cancer (EC), decrease of high irradiation dose to the heart without expanding the volume of lung irradiated low dose is needed, but this is not easy under the conventional techniques. Purpose of this study is to investigate the utility of volumetric modulated arc therapy using automated-radiotherapy planning software (auto-VMAT) to solve this issue. Methods: In this simulation study, data of 12 patients with stage I-III ECs previously treated by 3D-conformal radiotherapy (3DCRT) was used. We performed auto-VMAT planning using commercially available ‘Pinnacle3 Auto-Planning’ software. Targets for gross tumor (PTV1) and elective nodal region (PTV2), and organs at risk (OARs: lung, heart, left ventricle, epicardium, left pleura, liver and spinal cord) were delineated. Multi-portal beams were used for 3DCRT and dose description was 40 Gy in 20 fractions for PTV1+2 and 20 Gy in 10 fractions-boost for PTV1. We used the simultaneous integrated boost method for auto-VMAT with a dose description of 60 Gy for PTV1 and 48 Gy for PTV2 in 30 fractions. We performed planning in consideration with decrease of volumes irradiated middle to high dose in left ventricle and achievement of volume irradiated 5 Gy (V5) in lung < 50% as high-priority dose constraints. Results: Prescribed dose coverage of PTVs was equivalent between 3DCRT and auto-VMAT, while auto-VMAT showed better dose-conformity. Auto-VMAT showed a significant decrease of mean dose and V20-V60 in heart, left ventricle and epicardium and significant decrease of V50-V60 in lung and left pleura. V5 in lung was equivalent between 3DCRT and auto-VMAT (46.6±9.6% vs 45.6±4.7%; p = 0.72). Auto-VMAT achieved the V5 in lung < 50% in 10 among 12 patients and the max V5 in lung was 52.5%. Conclusions: Auto-VMAT for ECs achieved better dose conformity of targets, decrease of middle-high dose in heart, left ventricle and epicardium, and equivalent low dose volumes in lung. Auto-VMAT planning brings high quality dose distribution, uniformity of quality of planning, laborsaving and timesaving in treatment planning.

Intensity-modulated radiation therapy versus volumetric-modulated arc therapy in non-small cell lung cancer: assessing the risk of radiation pneumonitis

2017 ◽  
Vol 17 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Sara Rosas ◽  
Bárbara Barbosa ◽  
José G. Couto
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Radiation Pneumonitis ◽  
Volumetric Modulated Arc Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Intensity Modulated ◽  
Arc Therapy ◽  
Healthy Lung

AbstractPurposeThis study aimed to compare intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) regarding plan quality and healthy lung sparing, in stage III non-small cell lung cancer (NSCLC) patients.Materials and methodsThe plans of 60 patients were allocated either to the IMRT (n=30) or the VMAT (n=30) group. The dose prescribed to the planning target volume (PTV) was evaluated at the 95% level and the mean lung dose (MLD) and the healthy lung receiving 5, 10 and 20 Gy (V5, V10 and V20, respectively) were analysed. The normal tissue complication probability (NTCP) for radiation pneumonitis was calculated with the Lyman–Kutcher–Burman model.ResultsBoth techniques achieved comparable results for target coverage (V95%=97·87 versus 97·18%, p>0·05) and homogeneity. The MLD (15·57 versus 16·98 Gy, p>0·05), V5 (60·35 versus 67·25%, p>0·05) and V10 (45·22 versus 53·14%, p=0·011) were lower for IMRT, whereas VMAT reduced V20 (26·44 versus 25·90%, p>0·05). The NTCP for radiation pneumonitis was higher for VMAT, but no statistical significance was observed (11·07 versus 12·75, p>0·05).ConclusionBoth techniques seemed suitable for NSCLC treatment, but IMRT presented better results regarding lung sparing thus being beneficial in reducing the risk of radiation-induced pneumonitis.

scholarly journals Radiation pneumonitis in lung cancer treated with volumetric modulated arc therapy

2018 ◽  
Vol 10 (12) ◽  
pp. 6531-6539 ◽  
Author(s):  
Kan Wu ◽  
Xiao Xu ◽  
Xiadong Li ◽  
Jiahao Wang ◽  
Lucheng Zhu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Pneumonitis ◽  
Volumetric Modulated Arc Therapy ◽  
Arc Therapy
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