Arc therapy for total body irradiation – A robust novel treatment technique for standard treatment rooms

Jahnke, Anika; Jahnke, L.; Molina-Duran, Flavia; Ehmann, Michael; Kantz, Steffi; Steil, Volker; Wenz, Frederik; Glatting, Gerhard; Lohr, Frank; Poledník, Martin

doi:10.1016/j.radonc.2013.12.009

Cited by 35 publications

(41 citation statements)

References 27 publications

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“…To overcome that limitation, patients are generally placed at an extended distance away from the source and are treated supine and prone, or left and right, using a parallel opposed pair (pop) technique 16,17 . Other options include sweeping a beam across the patient or translating the patient through the beam [18][19][20] . Treatment delivery has traditionally used simple open fields, although modulated deliveries using tomotherapy and volumetric modulated arc therapy are also being used [21][22][23] .…”

Section: Introductionmentioning

confidence: 99%

Current Practice in Total-Body Irradiation: Results of a Canada-Wide Survey

et al. 2017

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Section: Introductionmentioning

confidence: 99%

Current Practice in Total-Body Irradiation: Results of a Canada-Wide Survey

et al. 2017

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“…Scanner could also help to achieve intensity‐modulated radiotherapy (IMRT), static or dynamic (arc therapy or tomotherapy), which improve the targeting of treatment areas and decrease the dose to organs at risk, by modulating the conformation, the number and intensity of the treatment beam. Indeed, the latter technique has been used for TBI in the pre‐conditioning allogeneic HSCT, with good dosimetric results . The advantage of these new treatment modalities (IMRT) is to improve the therapeutic ratio, with lower doses to OAR and increased conformation on tumor target volumes (lymph nodes).…”

Section: Discussionmentioning

confidence: 99%

Treatment of cutaneous and/or soft tissue manifestations of corticosteroids refractory chronic graft versus host disease (cGVHD) by a total nodal irradiation (TNI)

Peyraga

Lizée

Gustin

et al. 2017

Clinical Transplantation

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The management of corticosteroids refractory chronic graft versus host disease (cGVHD) remains controversial. Retrospective analysis of patients treated at the Integrated Center of Oncology by total nodal irradiation (TNI) was performed to evaluate its therapy potency. TNI delivers a dose of 1 Gy in a single session. The delimitation of the fields is clinical (upper limit: external auditory meatus; lower limit: mid-femur). No pre-therapeutic dosimetry scanner was necessary. Evaluation of the efficacy was by clinical measures at 6 months after the treatment. Twelve patients were treated by TNI between January 2010 and December 2013. TNI was used in second-line treatment or beyond. The median time between allograft and TNI was 31.2 months, and the median time between the first manifestations of cGVHD and TNI was about 24.2 months. Of the 12 patients, nine had a clinical response at 6 months (75%), including five complete clinical responses (41.6%). Five patients could benefit from a reduction of corticosteroid doses. Three patients had hematologic toxicity. TNI could be considered as an option for the treatment of a cutaneous and/or soft tissues corticosteroids refractory cGVHD. However, prospective randomized and double-blind trials remain essential to answer the questions about TNI safety and effectiveness.

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“…This anterior‐posterior (AP/PA) technique utilizes both supine and prone patient orientations at an extended source‐to‐surface distance (SSD) of approximately 175 cm, a custom bed oriented at 90° (IEC 601), and a beam spoiler. A 6 MV single‐isocenter sweeping arc between gantry angles 310° and 60° (IEC 601) was developed with control point weighting to account for inverse square law (ISL) effects and spoiler attenuation, similar to work done by Jahnke et al The linear accelerator (linac) gantry arcs over the patient 7‐8 times per setup orientation in order to deliver the required monitor units (MU) with a nominal dose rate of 600 MU/min. A schematic of the technique is illustrated in Fig.…”

Section: Methodsmentioning

confidence: 99%

Standardized flattening filter free volumetric modulated arc therapy plans based on anteroposterior width for total body irradiation

Frederick

Hudson

Balogh

et al. 2020

J Applied Clin Med Phys

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In this work, the feasibility of using flattening filter free (FFF) beams in volumetric modulated arc therapy (VMAT) total body irradiation (TBI) treatment planning to decrease protracted beam‐on times for these treatments was investigated. In addition, a methodology was developed to generate standardized VMAT TBI treatment plans based on patient physical dimensions to eliminate plan optimization time. A planning study cohort of 47 TBI patients previously treated with optimized VMAT ARC 6 MV beams was retrospectively examined. These patients were sorted into six categories depending on height and anteroposterior (AP) width at the umbilicus. Using Varian Eclipse, clinical 40 cm × 10 cm open field arcs were substituted with 6 MV FFF. Mid‐plane lateral dose profiles in conjunction with relative arc output factors (RAOF) yielded how far a given multileaf collimator (MLC) leaf must move in order to achieve a mid‐plane 100% isodose for a specific control point. Linear interpolation gave the dynamic MLC aperture for the entire arc for each patient AP width category, which was subsequently applied through Python scripting. All FFF VMAT TBI plans were then evaluated by two radiation oncologists and deemed clinically acceptable. The FFF and clinical VMAT TBI plans had similar Body–5 mm D98% distributions, but overall the FFF plans had statistically significantly increased or broader Body–5 mm D2% and mean lung dose distributions. These differences are not considered clinically significant. Median beam‐on times for the FFF and clinical VMAT TBI plans were 11.07 and 18.06 min, respectively, and planning time for the FFF VMAT TBI plans was reduced by 34.1 min. In conclusion, use of FFF beams in VMAT TBI treatment planning resulted in dose homogeneity similar to our current VMAT TBI technique. Clinical dosimetric criteria were achieved for a majority of patients while planning and calculated beam‐on times were reduced, offering the possibility of improved patient experience.

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Arc therapy for total body irradiation – A robust novel treatment technique for standard treatment rooms

Cited by 35 publications

References 27 publications

Current Practice in Total-Body Irradiation: Results of a Canada-Wide Survey

Current Practice in Total-Body Irradiation: Results of a Canada-Wide Survey

Treatment of cutaneous and/or soft tissue manifestations of corticosteroids refractory chronic graft versus host disease (cGVHD) by a total nodal irradiation (TNI)

Standardized flattening filter free volumetric modulated arc therapy plans based on anteroposterior width for total body irradiation

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