Clinical outcomes of 3D conformal hypofractionated single high-dose radiotherapy for one or two lung tumors using a stereotactic body frame

Nagata, Yasushi; Negoro, Yuji; Aoki, Takeshi; Mizowaki, Takashi; Takayama, Kenji; Kitajima, Masaki; Araki, Norio; Mitsumori, Michihide; Sasai, Keisuke; Shibamoto, Yuta; Koga, Sachiko; Yano, Shinsuke; Hiraoka, Masahiro

doi:10.1016/s0360-3016(01)02731-6

Cited by 266 publications

(134 citation statements)

References 18 publications

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“…The setup error (the reproducibility of patient position within the body frame) confirmed by the CTsimulator and verification films in every treatment was within 5 mm in all directions. Nagata et al also reported that the average set-up error using this stereotactic body frame was 3.2 mm [6]. Considering these results, the safety margin of the planning target volume was acceptable for adequately covering the gross tumor volume.…”

Section: Discussionmentioning

confidence: 70%

“…However, no patient treated at the dose of 48 Gy in 4 fractions (BED 105.6 Gy 10 ) had a local progression even though the follow-up period was relatively short. Nagata et al already recommended that a BED !/ 100 Gy might be effective for the stereotactic irradiation of a solitary lung cancer [6] and Timmerman et al reported that a local recurrence was observed most commonly at the lower doses (median 36 Gy in 3 fractions) but no patient had a local recurrence treated at dose of more than 54 Gy in 3 fractions in their phase I study [9]. A large retrospective Japanese multicenter analysis in 245 stage I lung cancer patients also reported better local control for BED ]/100 Gy compared with BED B/100 Gy (8.1% vs. 26.4%, p B/0.01) [21].…”

Section: Discussionmentioning

confidence: 99%

“…Since then, many authors have used extracranial stereotactic radiotherapy for treating primary or metastatic lung tumors with various doses and fractionation schedules and have reported its safety and efficacy for local tumor control [6Á11]. Some investigators have also reported promising results for inoperable stage I nonsmall cell lung cancer, which suggests that stereotactic radiotherapy might be an alternative to a surgical resection in early stage lung cancer patients with an advanced age, poor pulmonary function, and an acute or systemic illness [6,7,11].…”

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confidence: 99%

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Clinical results of stereotactic body frame based fractionated radiation therapy for primary or metastatic thoracic tumors

et al. 2006

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Clinical results of stereotactic body frame based fractionated radiation therapy for primary or metastatic thoracic tumors

et al. 2006

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“…Stereotactic body radiotherapy (SBRT) has been shown to be an effective treatment method of medically inoperable, early stage, non‐small cell lung cancer (NSCLC) 1 , 2 , 3 . Several groups have shown the efficacy of lung SBRT, using a combination of different immobilization and planning techniques, including static field techniques such as 3D conformal and intensity‐modulated radiotherapy (IMRT), as well as rotational techniques such as dynamic conformal arc and volumetric‐arc radiotherapy (VMAT).…”

Section: Introductionmentioning

confidence: 99%

Development and evaluation of a clinical model for lung cancer patients using stereotactic body radiotherapy (SBRT) within a knowledge‐based algorithm for treatment planning

Snyder

Kim

Reding

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to describe the development of a clinical model for lung cancer patients treated with stereotactic body radiotherapy (SBRT) within a knowledge‐based algorithm for treatment planning, and to evaluate the model performance and applicability to different planning techniques, tumor locations, and beam arrangements. 105 SBRT plans for lung cancer patients previously treated at our institution were included in the development of the knowledge‐based model (KBM). The KBM was trained with a combination of IMRT, VMAT, and 3D CRT techniques. Model performance was validated with 25 cases, for both IMRT and VMAT. The full KBM encompassed lesions located centrally vs. peripherally (43:62), upper vs. lower (62:43), and anterior vs. posterior (60:45). Four separate sub‐KBMs were created based on tumor location. Results were compared with the full KBM to evaluate its robustness. Beam templates were used in conjunction with the optimizer to evaluate the model's ability to handle suboptimal beam placements. Dose differences to organs‐at‐risk (OAR) were evaluated between the plans generated by each KBM. Knowledge‐based plans (KBPs) were comparable to clinical plans with respect to target conformity and OAR doses. The KBPs resulted in a lower maximum spinal cord dose by 1.0±1.6Gy compared to clinical plans, p=0.007. Sub‐KBMs split according to tumor location did not produce significantly better DVH estimates compared to the full KBM. For central lesions, compared to the full KBM, the peripheral sub‐KBM resulted in lower dose to 0.035 cc and 5 cc of the esophagus, both by 0.4Gy±0.8Gy, p=0.025. For all lesions, compared to the full KBM, the posterior sub‐KBM resulted in higher dose to 0.035 cc, 0.35 cc, and 1.2 cc of the spinal cord by 0.2±0.4Gy, p=0.01. Plans using template beam arrangements met target and OAR criteria, with an increase noted in maximum heart dose (1.2±2.2Gy, p=0.01) and GI (0.2±0.4, p=0.01) for the nine‐field plans relative to KBPs planned with custom beam angles. A knowledge‐based model for lung SBRT consisting of multiple treatment modalities and lesion locations produced comparable plan quality to clinical plans. With proper training and validation, a robust KBM can be created that encompasses both IMRT and VMAT techniques, as well as different lesion locations.PACS number(s): 87.55de, 87.55kh, 87.53Ly

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“…Dynamic conformal arc therapy (DCAT) technique has been implemented in linear accelerator (linac) based stereotactic body radiotherapy (SBRT) for patients with Stage I/II non‐small‐cell lung cancer (NSCLC) 1, 2, 3, 4, 5, 6, 7, 8, 9. One advantage of DCAT technique is the robust and transferable treatment methodology in planning, which is capable of reproducing the same or similar optimized planning results on different planning systems 7, 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

Effects of collimator angle, couch angle, and starting phase on motion‐tracking dynamic conformal arc therapy (4D DCAT)

Yao

Podgorsak

et al. 2017

J Applied Clin Med Phys

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PurposeThe aim of this study was to find an optimized configuration of collimator angle, couch angle, and starting tracking phase to improve the delivery performance in terms of MLC position errors, maximal MLC leaf speed, and total beam‐on time of DCAT plans with motion tracking (4D DCAT).Method and materialsNontracking conformal arc plans were first created based on a single phase (maximal exhalation phase) of a respiratory motion phantom with a spherical target. An ideal model was used to simulate the target motion in superior‐inferior (SI), anterior‐posterior (AP), and left‐right (LR) dimensions. The motion was decomposed to the MLC leaf position coordinates for motion compensation and generating 4D DCAT plans. The plans were studied with collimator angle ranged from 0° to 90°; couch angle ranged from 350°(−10°) to 10°; and starting tracking phases at maximal inhalation (θ=π/2) and exhalation (θ=0) phases. Plan performance score (PPS) evaluates the plan complexity including the variability in MLC leaf positions, degree of irregularity in field shape and area. PPS ranges from 0 to 1, where low PPS indicates a plan with high complexity. The 4D DCAT plans with the maximal and the minimal PPS were selected and delivered on a Varian TrueBeam linear accelerator. Gafchromic‐EBT3 dosimetry films were used to measure the dose delivered to the target in the phantom. Gamma analysis for film measurements with 90% passing rate threshold using 3%/3 mm criteria and trajectory log files were analyzed for plan delivery accuracy evaluation.ResultsThe maximal PPS of all the plans was 0.554, achieved with collimator angle at 87°, couch angle at 350°, and starting phase at maximal inhalation (θ=π/2). The maximal MLC leaf speed, MLC leaf errors, total leaf travel distance, and beam‐on time were 20 mm/s, 0.39 ± 0.16 mm, 1385 cm, and 157 s, respectively. The starting phase, whether at maximal inhalation or exhalation had a relatively small contribution to PPS (0.01 ± 0.05).ConclusionsBy selecting collimator angle, couch angle, and starting tracking phase, 4D DCAT plans with the maximal PPS demonstrated less MLC leaf position errors, lower maximal MLC leaf speed, and shorter beam‐on time which improved the performance of 4D motion‐tracking DCAT delivery.

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Clinical outcomes of 3D conformal hypofractionated single high-dose radiotherapy for one or two lung tumors using a stereotactic body frame

Cited by 266 publications

References 18 publications

Clinical results of stereotactic body frame based fractionated radiation therapy for primary or metastatic thoracic tumors

Clinical results of stereotactic body frame based fractionated radiation therapy for primary or metastatic thoracic tumors

Development and evaluation of a clinical model for lung cancer patients using stereotactic body radiotherapy (SBRT) within a knowledge‐based algorithm for treatment planning

Effects of collimator angle, couch angle, and starting phase on motion‐tracking dynamic conformal arc therapy (4D DCAT)

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