Comparison of end normal inspiration and expiration for gated intensity modulated radiation therapy (IMRT) of lung cancer

Biancia, Cesar Della; Yorke, Ellen; Chui, Chen‐Shou; Giraud, P.; Rosenzweig, Kenneth E.; Amols, Howard; Ling, C. Clifton; Mageras, G.

doi:10.1016/j.radonc.2005.01.008

Cited by 47 publications

(41 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results show that with respect to gating at endexhale, gating at end-inhale may result in slightly reduced lung dose, however, the reductions in lung BED and NTD are on average ≤0.4 Gy, and these reductions are statistically not significant. Our conclusions are consistent with the results obtained by Biancia et al [36]. In Biancia et al, IMRT plans performed at end-inhale were compared with plans performed at end-exhale for 10 patients.…”

Section: Discussionsupporting

confidence: 92%

An evaluation of planning techniques for stereotactic body radiation therapy in lung tumors

Shekhar

et al. 2008

Radiotherapy and Oncology

View full text Add to dashboard Cite

Purpose-To evaluate four planning techniques for stereotactic body radiation therapy (SBRT) in lung tumors.Methods and Materials-Four SBRT plans were performed for 12 patients with stage I/II nonsmall-cell lung cancer under the following conditions: (1) conventional margins on free-breathing CT (plan 1), (2) generation of an internal target volume (ITV) using 4DCT with beam delivery under free-breathing conditions (plan 2), (3) gating at end-exhale (plan 3), and (4) gating at end-inhale (plan 4). Planning was performed following the RTOG 0236 protocol with a prescription dose of 54Gy (3 fractions). For each plan 4D dose was calculated using deformable image registration.Results-There was no significant difference in tumor dose delivered by the 4 plans. However, compared with plan 1, plans 2-4 reduced total lung BED by 1.9±1.2Gy, 3.1±1.6Gy and 3.5±2.1Gy, reduced mean lung dose by 0.8±0.5Gy, 1.5±0.8Gy, and 1.6±1.0Gy, reduced V20 by 1.5±1.0%, 2.7 ±1.4%, and 2.8±1.8% respectively with p<0.01. Compared with plan 2, plans 3-4 reduced lung BED by 1.2±1.0Gy and 1.6±1.5Gy, reduced mean lung dose by 0.6±0.5Gy and 0.8±0.7Gy, reduced V20 by 1.2±1.1% and 1.3±1.5% respectively with p<0.01. The differences in lung BED, mean dose and V20 of plan 4 compared with plan 3 are insignificant.Conclusions-Tumor dose coverage was statistically insignificant between all plans. However, compared with plan 1, plans 2-4 significantly reduced lung doses. Compared with plan 2, plan 3-4 also reduced lung toxicity. The difference in lung doses between plan 3 and plan 4 was not significant.

show abstract

Section: Discussionsupporting

confidence: 92%

An evaluation of planning techniques for stereotactic body radiation therapy in lung tumors

Shekhar

et al. 2008

Radiotherapy and Oncology

View full text Add to dashboard Cite

show abstract

“…We have previously compared the planning system's dose distributions and dose-volume histograms (DVH) with Monte-Carlo calculations of the same plans for 3D-CRT and IMRT lung plans and have observed similar effects for both techniques. [40][41][42] The outcomes reported in our study with using IMRT are comparable to results from other studies that have used 3D-CRT for NSCLC. In a prospective dose escalation study, Hayman et al reported 2-year OS of 40% with median survival time of 18 months and 2-year progression-free survival of 17% in patients with stage I-IIIB disease.…”

Section: Discussionsupporting

confidence: 85%

Intensity-modulated radiation therapy (IMRT) for inoperable non-small cell lung cancer: The Memorial Sloan-Kettering Cancer Center (MSKCC) experience

Sura

Gupta

Yorke

et al. 2008

Radiotherapy and Oncology

Self Cite

126

View full text Add to dashboard Cite

show abstract

“…The average lung volume changes from EE to EI for the subjects were within 8% ¡ 5%, less than those for the treatment of NSCLC using deep inspiration breathhold or deep expiration breath-hold. This result concurred with the results of Biancia et al [7], who reported clinically insignificant differences between EE and EI in patients under normal respiration conditions.…”

Section: Discussionsupporting

confidence: 93%

“…At present, there are two different philosophies for applying gating phases: during expiration [6] and during inspiration [7,8]. The former approach advocates that tumour motion is comparatively stable during exhalation, which minimises the respiratory-induced target motion and allows better reproducibility of margin size.…”

mentioning

confidence: 99%

“…The former approach advocates that tumour motion is comparatively stable during exhalation, which minimises the respiratory-induced target motion and allows better reproducibility of margin size. Conversely, the latter approach is based on the argument that, during lung inflation, more normal lung tissue can be spared during the irradiation [7]. In this study, a comparison is made between the use of endinspiration (EI) and end-expiration (EE) gated IMRT treatment for a set of NSCLC patients using dosimetric and associated biological indicators.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A study on the influence of breathing phases in intensity-modulated radiotherapy of lung tumours using four-dimensional CT

Wu¹,

Chan²,

Wong³

et al. 2010

BJR

View full text Add to dashboard Cite

ABSTRACT. During gated intensity-modulated radiotherapy (IMRT) treatment for patients with inoperable non-small cell lung cancer (NSCLC), the end-expiration (EE) phase of respiratory is more stable, whereas end-inspiration (EI) spares more normal lung tissue. This study compared the relative plan quality based on dosimetric and biological indices of the planning target volume (PTV) and organs at risk (OARs) between EI and EE in gated IMRT. 16 Stage I NSCLC patients, who were scanned by four-dimensional CT, were recruited and re-planned. An IMRT plan of a prescription dose of 60 Gy per respiratory phase was computed using the iPlan treatment planning system. The heart, spinal cord, both lungs and PTV were outlined. The tumour control probability for the PTV and normal tissue complication probability for all OARs in the EE and EI phases were nearly the same; only the normal tissue complication probability of the heart in EE was slightly lower. Conversely, the conformation number of the PTV, V 20 of the left lung, V 30 of both lungs, D max of the heart and spinal cord, V 10 of the heart and D 5% of the spinal cord were better in EE, whereas D mean of the PTV, V 20 of the right lung and maximum doses of both lungs were better in EI. No differences reached statistical significance (p,0.05) except D max of the spinal cord (p50.033). Overall, there was no expected clinical impact between EI and EE in the study. However, based on the practicality factor, EI is recommended for patients who can perform breath-hold; otherwise, EE is recommended. Non-small cell lung cancer (NSCLC) [1,2] accounts for 80% of all lung cancers for which radiotherapy (RT) is the treatment of choice for inoperable cases. However, the survival rate with RT is low. This, in part, is a result of respiratory motion [3], which may cause a planning target volume (PTV) displacement of more than 2.5 cm [4], leading to a geographic miss or unnecessary irradiation of adjacent normal tissues and organs at risk (OARs). This phenomenon involves different sizes and motion of the PTV at different phases of the breathing cycle, and therefore results in different PTV dose coverage [5].With the development of four-dimensional CT (4D-CT), intensity-modulated radiotherapy (IMRT) and gating, it is possible to achieve better accuracy, precision and clinical outcomes. At present, there are two different philosophies for applying gating phases: during expiration [6] and during inspiration [7,8]. The former approach advocates that tumour motion is comparatively stable during exhalation, which minimises the respiratory-induced target motion and allows better reproducibility of margin size. Conversely, the latter approach is based on the argument that, during lung inflation, more normal lung tissue can be spared during the irradiation [7]. In this study, a comparison is made between the use of endinspiration (EI) and end-expiration (EE) gated IMRT treatment for a set of NSCLC patients using dosimetric and associated biological indicators. Methods and materials SubjectsThis...

show abstract

Comparison of end normal inspiration and expiration for gated intensity modulated radiation therapy (IMRT) of lung cancer

Cited by 47 publications

References 36 publications

An evaluation of planning techniques for stereotactic body radiation therapy in lung tumors

An evaluation of planning techniques for stereotactic body radiation therapy in lung tumors

Intensity-modulated radiation therapy (IMRT) for inoperable non-small cell lung cancer: The Memorial Sloan-Kettering Cancer Center (MSKCC) experience

A study on the influence of breathing phases in intensity-modulated radiotherapy of lung tumours using four-dimensional CT

Contact Info

Product

Resources

About