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Dosimetric Comparisons of Lung SBRT with Multiple Metastases by Two Advanced Planning Systems

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DOI: 10.4236/ijmpcero.2014.34032    3,731 Downloads   4,552 Views   Citations

ABSTRACT

Purpose: To evaluate planning quality of Stereotactic body Radiotherapy (SBRT) with multiple lungmetastases generated by the Pinnacle and Tomotherapy planning systems, respectively. Methods and Materials: Nine randomly selected patients diagnosed with non-small cell lung carcinoma with multiple lesions were planned with Philips Pinnacle (version 9.2, Fitchburg, WI) and Tomotherapy (version 4.2, Madison, WI), respectively. Both coplanar and non-coplanar IMRT plans were generated on Pinnacle system. A total dose of 60 Gy was prescribed to cover 95% of Planning Target Volume (PTV) in 3 fractions based on the RTOG0236 protocol prescription [1]. All plans with single isocenter setting were used for multiple lesions planning. A set of nine static beams were used for Pinnacle plansusing Direct Machine Parameters Optimization (DMPO) algorithm of RTOT0236 dose constraints. Planning outcomes such as minimum and mean doses, V95, D95 (95% of target volume receivesprescription dose), D5, and D1 to PTV, maximum dose to heart, esophagus, cord, trachea, brachial plexus, rib, chest wall, and liver, mean dose toliver, total lung, right and left lung, volume of chest wall receives 30 Gy, volume of lungs receives 5 Gy and 20 Gy (V5 and V20), conformity index (CI) and heterogeneity index (HI) were all reported for evaluation. Results: Mean volume of PTV was 37.77 ± 23.4 cm3. D95 of PTV with Tomotherapy, coplanar, non-coplanar plan was 60.2 ± 0.3 Gy, 58.6 ± 1.2 Gy, and 59.1 ± 0.7 Gy, respectively. Mean dose to PTV was lower for Tomotherapy (p < 0.0001), so were D5 (p < 0.0001) and D1 (p = 0.001). CI was higher with Tomotherapyplans (p < 0.0001), so was HI (p < 0.0001). Maximum dose to other critical organs were also lower exclusively with Tomotherapy plans, as expected. Treatment time was recorded only for Tomotherapy plans (73.0 ± 20.6 min) while the Intensity Modulated Radiation Therapy (IMRT) plan from Pinnacle were not registered for comparison in those cases. Conclusions: With 51 beam angles per rotation, Tomotherapy plans could generally achieve better tumor coverage while sparing more critical structures in the multiple lung lesions study. Non-coplanar IMRT plans also have better tumor coverage with lower dose to critical organs such as lungs, liver, chest wall and cord compare to coplanar plans. Compared to the coplanar IMRT beam plans, Tomotherapy tends to have a relatively higher low dose volume in lungs such as V5 which needs more attention for toxicity analysis.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Zhang, Y. , Chen, Y. , Qiu, J. and Yang, J. (2014) Dosimetric Comparisons of Lung SBRT with Multiple Metastases by Two Advanced Planning Systems. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 3, 252-261. doi: 10.4236/ijmpcero.2014.34032.

References

[1] Timmerman, R.D., Michalski, J., Fowler, J., et al. (2008) A Phase II Trial of Stereotactic Body Radiation Therapy (SBRT) in the Treatment of Patients with Medically Inoperable Stage I/II Non-Small Cell Lung Cancer, Protocol 0236. RTOG, Philadelphia.
http://www.rtog.org/members/protocols/0236/0236.pdf
[2] Pastorino, U., Buyse, M., Friedel, G., Ginsberg, R.J., Girard, P., Goldstraw, P. and Putnam Jr., J.B. (1997) Long-Term Results of Lung Metastasectomy: Prognostic analyses Based on 5206 Cases. The Journal of Thoracic and Cardiovascular Surgery, 113, 37-49.
http://dx.doi.org/10.1016/S0022-5223(97)70397-0
[3] Sternberg, D.I. and Sonett, J.R. (2007) Surgical Therapy of Lung Metastases. Seminars in Oncology, 34, 186-196.
http://dx.doi.org/10.1053/j.seminoncol.2007.03.004
[4] Iyengar, P. and Timmerman, R.D. (2012) Stereotactic Ablative Radiotherapy for Non-Small Cell Lung Cancer: Rationale and Outcomes. Journal of the National Comprehensive Cancer Network, 10, 1514-1520.
[5] Timmerman, R. (2010) Stereotactic Body Radiation Therapy for Inoperable Early Stage Lung Cancer. JAMA, 303, 1070-1076.
http://dx.doi.org/10.1001/jama.2010.261
[6] Weichselbaum, R.R. and Hellman, S. (2011) Oligometastases Revisited. Nature Reviews Clinical Oncology, 8, 378-382.
[7] Kelly, P., Balter, P. A., Rebueno, N., Sharp, H. J., Liao, Z., Komaki, R. and Chang, J. Y. (2010) Stereotactic Body Radiation Therapy for Patients with Lung Cancer Previously Treated with Thoracic Radiation. International Journal of Radiation Oncology, Biology, Physics, 78, 1387-1393.
http://dx.doi.org/10.1016/j.ijrobp.2009.09.070
[8] Okunieff, P., Petersen, A.L., Philip, A., Milano, M.T., Katz, A.W., Boros, L. and Schell, M.C. (2006) Stereotactic Body Radiation Therapy (SBRT) for Lung Metastases. Acta Oncologica, 45, 808-817.
http://dx.doi.org/10.1080/02841860600908954
[9] Kavanagh, B.D., McGarry, R.C. and Timmerman, R.D. (2006) Extracranial Radiosurgery (Stereotactic Body Radiation Therapy) for Oligometastases. Seminars in Radiation Oncology, 16, 77-84.
http://dx.doi.org/10.1016/j.semradonc.2005.12.003
[10] Onishi, H., Shirato, H., Nagata, Y., Hiraoka, M., Fujino, M., Gomi, K. and Araki, T. (2007) Hypofractionated Stereotactic Radiotherapy (HypoFXSRT) for Stage I Non-Small Cell Lung Cancer: Updated Results of 257 Patients in Japanese Multi-Institutional Study. Journal of Thoracic Oncology, 2, S94-S100.
http://dx.doi.org/10.1097/JTO.0b013e318074de34
[11] Timmerman, R.D., Bizekis, C.S., Pass, H.I., Fong, Y., Dupuy, D.E., Dawson, L.A., et al. (2009) Local Surgical, Ablative, and Radiation Treatment of Metastases. CA: A Cancer Journal for Clinicians, 59, 145-170.
http://dx.doi.org/10.3322/caac.20013
[12] Rusthoven, K.E., Kavanagh, B.D., Burri, S.H., Chen, C., Cardenes, H., Chidel, M.A., et al. (2009) Multi-Institutional Phase I/II Trial of Stereotactic Body Radiation Therapy for Lung Metastases. Journal of Clinical Oncology, 27, 1579-1584.
http://dx.doi.org/10.1200/JCO.2008.19.6386
[13] Fong, Y., Fortner, J., Sun, R.L., Brennan, M.F. and Blumgart, L.H. (1999) Clinical Score for Predicting Recurrence after Hepatic Resection for Metastatic Colorectal Cancer: Analysis of 1001 Consecutive Cases. Annals of Surgery, 230, 309.
http://dx.doi.org/10.1097/00000658-199909000-00004
[14] Timmerman, R.D., Park, C. and Kavanagh, B.D. (2007) The North American Experience with Stereotactic Body Radiation Therapy in Non-Small Cell Lung Cancer. Journal of Thoracic Oncology, 2, S101-S112.
http://dx.doi.org/10.1097/JTO.0b013e318074e4fa
[15] Soldà, F., Lodge, M., Ashley, S., Whitington, A., Goldstraw, P. and Brada, M. (2013) Stereotactic Radiotherapy (SABR) for the Treatment of Primary Non-Small Cell Lung Cancer; Systematic Review and Comparison with a Surgical Cohort. Radiotherapy and Oncology, 109, 1-7.
http://dx.doi.org/10.1016/j.radonc.2013.09.006
[16] Dunlap, N.E., Larner, J.M., Read, P.W., Kozower, B.D., Lau, C.L., Sheng, K., et al. (2010) Size Matters: A Comparison of T1 and T2 Peripheral Non-Small-Cell Lung Cancers Treated with Stereotactic Body Radiation Therapy (SBRT). The Journal of Thoracic and Cardiovascular Surgery, 140, 583-589.
http://dx.doi.org/10.1016/j.jtcvs.2010.01.046
[17] Hartford, A.C., Galvin, J.M., Beyer, D.C., Eichler, T.J., Ibbott, G.S., Kavanagh, B., et al. (2012) American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) Practice Guideline for Intensity-Modulated Radiation Therapy (IMRT). American Journal of Clinical Oncology, 35, 612-617.
http://dx.doi.org/10.1097/COC.0b013e31826e0515
[18] Potters, L., Gaspar, L.E., Kavanagh, B., Galvin, J.M., Hartford, A.C., Hevezi, J.M., et al. (2010) American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) Practice Guidelines for Image-Guided Radiation Therapy (IGRT). International Journal of Radiation Oncology, Biology, Physics, 76, 319-325.
http://dx.doi.org/10.1016/j.ijrobp.2009.09.041
[19] Potters, L., Kavanagh, B., Galvin, J.M., Hevezi, J.M., Janjan, N.A., Larson, D.A., et al. (2010) American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Performance of Stereotactic Body Radiation Therapy. International Journal of Radiation Oncology, Biology, Physics, 76, 326-332.
http://dx.doi.org/10.1016/j.ijrobp.2009.09.042
[20] Solberg, T.D., Balter, J.M., Benedict, S.H., Fraass, B.A., Kavanagh, B., Miyamoto, C. and Yamada, Y. (2012) Quality and Safety Considerations in Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy: Executive Summary. Practical Radiation Oncology, 2, 2.
[21] Lo, S.S., Fakiris, A.J., Chang, E.L., Mayr, N.A., Wang, J.Z., Papiez, L., et al. (2009) Stereotactic Body Radiation Therapy: A Novel Treatment Modality. Nature Reviews Clinical Oncology, 7, 44-54.
http://dx.doi.org/10.1038/nrclinonc.2009.188
[22] Nagata, Y., Takayama, K., Matsuo, Y., Norihisa, Y., Mizowaki, T., Sakamoto, T., et al. (2005) Clinical Outcomes of a Phase I/II Study of 48 Gy of Stereotactic Body Radiotherapy in 4 Fractions for Primary Lung Cancer Using a Stereotactic Body Frame. International Journal of Radiation Oncology, Biology, Physics, 63, 1427-1431.
http://dx.doi.org/10.1016/j.ijrobp.2005.05.034
[23] Milano, M.T., Katz, A.W., Muhs, A.G., Philip, A., Buchholz, D.J., Schell, M.C. and Okunieff, P. (2008) A Prospective Pilot Study of Curative-Intent Stereotactic Body Radiation Therapy in Patients with 5 or Fewer Oligometastatic Lesions. Cancer, 112, 650-658.
http://dx.doi.org/10.1002/cncr.23209
[24] Siva, S., MacManus, M. and Ball, D. (2010) Stereotactic Radiotherapy for Pulmonary Oligometastases: A Systematic Review. Journal of Thoracic Oncology, 5, 1091-1099.
[25] Halpern, E.C., Perez, C.A. and Brady, L.W. (2008) Perez and Brady’s Principle and Practice of Radiation Oncology. 5th Edition, Lippincott Williams and Wilkins, Philadelphia.
[26] Sterzing, F., Welzel, T., Sroka-Perez, G., Schubert, K., Debus, J. and Herfarth, K.K. (2009) Reirradiation of Multiple Brain Metastases with Helical Tomotherapy. Strahlentherapie und Onkologie, 185, 89-93.
http://dx.doi.org/10.1080/02841860600900050
[27] Li, Q., Mu, J., Gu, W., Chen, Y., Ning, Z., Jin, J. and Pei, H. (2014) Frameless Stereotactic Body Radiation Therapy for Multiple Lung Metastases. Journal of Applied Clinical Medical Physics, 15, 105-116.
[28] Lax, I., Panettieri, V. and Wennberg, B. (2006) Dose Distributions in SBRT of Lung Tumors: Comparison between Two Different Treatment Planning Algorithms and Monte-Carlo Simulation Including Breathing Motions. Acta Oncologica, 45, 978-988.
http://dx.doi.org/10.1080/02841860600900050
[29] Kim, Y., Hong, S.E., Kong, M. and Choi, J. (2013) Predictive Factors for Radiation Pneumonitis in Lung Cancer Treated with Helical Tomotherapy. Cancer Research and Treatment, 45, 295-302.
http://dx.doi.org/10.4143/crt.2013.45.4.295

  
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