Dosimetric evaluation of different planning techniques based on flattening filter-free beams for central and peripheral lung stereotactic body radiotherapy

Dwivedi, Shekhar; Kansal, Sandeep; Shukla, Jooli; Bharati, Avinav; Dangwal, Vinod Kumar

doi:10.1088/2057-1976/ac2f0d

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…It's crucial to note that the performance of both DMLC and VMAT plans is heavily reliant on the optimization functions and the speci c characteristics of the tumor and surrounding normal tissues. As a result, it's feasible that DMLC could outperform VMAT in terms of conformity in certain instances, despite VMAT generally being presumed to offer better or at least equal conformity [23][24][25] . Overall, both VMAT and DMLC plans can achieve comparable dose distributions in SBRT.…”

Section: Discussionmentioning

confidence: 99%

A Dosimetric Comparison of Stereotactic Body Radiation Therapy for Lung Tumors: Plans of Gamma Knife, and Volumetric Modulated Arc Therapy, Dynamic Multileaf Collimator Plans based on Linear Accelerator

Duan,

Wu,

Zhu

et al. 2024

Preprint

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Objective This study evaluates dosimetric differences in Stereotactic Body Radiation Therapy (SBRT) for lung tumors using plans of Gamma Knife, and Volumetric Modulated Arc Therapy (VMAT), Dynamic Multileaf Collimator (DMLC) plans based on Linear Accelerator, aiming to inform the reader of appropriate treatment strategy selection. Methods Ten patients with 23 lung tumor lesions treated with SBRT at Zhongshan Hospital of Dalian University were analyzed. Plans of Gamma Knife, and VMAT, DMLC plans based on Linear Accelerator were created for each lesion, totaling 18 plans per type. Lesions were treated with 30-50 Gy in 5-10 fractions. Dosimetric parameters, including gradient index (GI), heterogeneity index (HI), conformity index (CI), and doses to the plan target volumes (PTVs), the gross tumor volumes (GTVs) and organs at risk (OARs) were compared. Results Plans of Gamma Knife showed superior HI and GI, higher PTV and GTV doses, and reduced doses to the ipsilateral and contralateral lungs, esophagus, spinal cord, and heart compared to VMAT and DMLC plans (p< 0.05). However, Plans of Gamma Knife required longer delivery times. When comparing VMAT and DMLC plans，VMAT plans had shorter delivery times than DMLC plans, but required more monitor units (MUs). Additionally, DMLC plans delivered a lower mean dose to the ipsilateral lung compared to VMAT plans. Conclusions Gamma Knife SBRT plans achieves steeper dose falloff and minimizes radiation to normal lung tissue compared to VMAT and DMLC plans, but with longer delivery times. VMAT and DMLC plans displayed similar dose distributions for lung SBRT.

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Section: Discussionmentioning

confidence: 99%

A Dosimetric Comparison of Stereotactic Body Radiation Therapy for Lung Tumors: Plans of Gamma Knife, and Volumetric Modulated Arc Therapy, Dynamic Multileaf Collimator Plans based on Linear Accelerator

Duan,

Wu,

Zhu

et al. 2024

Preprint

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“…In the case of (FFF) VMAT plans, the treatment delivery time is primarily constrained by the rotational speed of the gantry, rather than the dose rate. Accelerated delivery may potentially decrease the likelihood of intra-fractional setup inaccuracies, which have been reported to occur in treatment procedures lasting over 15 minutes [7,12].…”

Section: Discussionmentioning

confidence: 99%

“…The phantom is a 175 cm, 73.5 kg male body sliced at 2.5 cm intervals. [6,7] Simulation: A CT scan of 25mm slices of the phantom is performed to create a 3D image of the phantom. This image is used to develop a treatment plan, similar to what would be done for a patient.…”

Section: Methodsmentioning

confidence: 99%

Dosimetric Evaluation Study of 10-MV FFF Used in SBRT for Lung Tumours

Soliman,

Attia,

Elshahat

2023

East Eur. J. Phys.

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Purpose: The objective of this research was to conduct a comparative and dosimetric analysis of three different radiotherapy techniques used in lung stereotactic body radiotherapy (SBRT), the three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT), using a 10 MV flattening filter-free (FFF) photon beam. Materials and methods: The present study employed computed tomography (CT) images of a humanoid phantom for the purpose of treatment planning. The gross tumour volumes (GTVs) delineated in both the central and peripheral positions of the lungs. The determination of Planning Target Volumes (PTVs) involved the addition of a margin of 0.5 cm to the Gross Tumour Volume (GTV). Three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT) treatment plans produced employing a 10-megavolt (MV) flattening filter-free (FFF) photon beam. The calculation of dosage for all plans Performed using the anisotropic analytical algorithm (AAA). Results: IMRT and VMAT had better PTV dose conformation than 3DCRT for both central and peripheral targets. PTV conformity improved in VMAT compared to IMRT, and CI values were acceptable for VMAT, IMRT, and 3DCRT plans. VMAT plans had slightly better CI than IMRT, with better results in peripheral lung PTVs compared to central PTVs. VMAT and IMRT are superior for treating HDV and D2cm, with lower HDV for peripheral lung tumours. Both 3DCRT and IMRT improved outcomes for peripheral lung PTVs, while VMAT was better for central lung PTVs. The former proved better with less low lung doses and improved D2cm results. 3DCRT plans demonstrated higher precision in dose distribution than VMAT and IMRT plans, with superior average GI values. VMAT and IMRT had higher HI, Dmax, and D2% than 3DCRT. VMAT plans compared to IMRT plans, with similar HI values for central lung PTVs. VMAT better spares OARs than other techniques, but V20 and V30 lung doses were lower with 3DCRT. VMAT increases lung dose, but OAR stays below thresholds. Conclusion: The investigation found that all three treatment techniques can deliver SBRT plans that meet RTOG dose constraints. However, VMAT is a better treatment strategy than IMRT and 3DCRT for both peripheral and central lung PTVs, based on dosimetric indices like CI, D2cm, HI, and HDV. The study found that 3DCRT improves dosimetric indices, especially gradient index (GI), more than VMAT. Despite the need for more monitor units (MUs) in VMAT plans, treatment time reduced due to faster gantry velocity and higher dose rates (2400cGy/min) via free flatting filter energy.

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“…Recently, several reports have examined various VMAT techniques for treating lung cancer, analyzing their impact on normal lung dose and confirming their feasibility. 14 , 15 , 16 One of those studies investigated the benefit of the fixed jaw and jaw tracking VMAT technique, one study evaluated the benefit of the flattened filter‐free photon beam, and one study added a non‐coplanar arc to reduce dose to organs at risk (OAR). Nevertheless, to our knowledge, nearly none of the studies investigated the dosimetric effect of dual‐isocenter jaw‐tracking VMAT in lung cancer with a large longitudinal tumor target.…”

Section: Introductionmentioning

confidence: 99%

“…Meanwhile, radiotherapy technology has continued to evolve. Recently, several reports have examined various VMAT techniques for treating lung cancer, analyzing their impact on normal lung dose and confirming their feasibility 14–16 . One of those studies investigated the benefit of the fixed jaw and jaw tracking VMAT technique, one study evaluated the benefit of the flattened filter‐free photon beam, and one study added a non‐coplanar arc to reduce dose to organs at risk (OAR).…”

Section: Introductionmentioning

confidence: 99%

Single isocenter versus dual isocenter treatment using flattening filter‐free and jaw‐tracking volumetrically modulated arc therapy for boot‐shaped lung cancer: Evaluation of dosimetric and feasibility

Zhang,

Cheng,

et al. 2024

J Applied Clin Med Phys

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BackgroundTo determine whether a dual‐isocenter volumetrically modulated arc therapy (VMAT) technique results in lower normal pulmonary dosage compared to a traditional single isocenter technique for boot‐shaped lung cancer.MethodsA cohort of 15 patients with advanced peripheral or central lung cancer who had metastases in the mediastinum and supraclavicular lymph nodes was randomly selected for this retrospective study. VMAT plans were generated for each patient using two different beam alignment techniques with the 6‐MV flattening filter‐free (FFF) photon beam: single‐isocenter jaw‐tracking VMAT based on the Varian TrueBeam linear accelerator (S‐TV), and dual‐isocenter VMAT based on both TrueBeam (D‐TV) and Halcyon linear accelerator (D‐HV). For all 45 treatment plans, planning target volume (PTV) dose coverage, conformity/homogeneity index (CI/HI), mean heart dose (MHD), mean lung dose (MLD) and the total lung tissue receiving 5, 20, 30 Gy (V5, V20, V30) were evaluated. The monitor units (MUs), delivery time, and plan quality assurance (QA) results were recorded.ResultsThe quality of the objectives of the three plans was comparable to each other. In comparison with S‐TV, D‐TV and D‐HV improved the CI and HI of the PTV (p < 0.05). The MLD was 13.84 ± 1.44 Gy (mean ± SD) for D‐TV, 14.22 ± 1.30 Gy and 14.16 ± 1.42 Gy for S‐TV and D‐HV, respectively. Lungs‐V5Gy was 50.78 ± 6.24%, 52.00 ± 7.32% and 53.36 ± 8.48%, Lungs‐V20Gy was 23.72 ± 2.27%, 26.18 ± 2.86% and 24.96 ± 3.09%, Lungs‐V30Gy was 15.69 ± 1.76%, 17.20 ± 1.72% and 16.52 ± 2.07%. Compared to S‐TV, D‐TV provided statistically significant better protection for the total lung, with the exception of the lungs‐V5. All plans passed QA according the gamma criteria of 3%/3 mm.ConclusionsTaking into account the dosimetric results and published clinical data on radiation‐induced pulmonary injury, dual‐isocenter jaw‐tracking VMAT may be the optimal choice for treating boot‐shaped lung cancer.

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Dosimetric evaluation of different planning techniques based on flattening filter-free beams for central and peripheral lung stereotactic body radiotherapy

Cited by 6 publications

References 33 publications

A Dosimetric Comparison of Stereotactic Body Radiation Therapy for Lung Tumors: Plans of Gamma Knife, and Volumetric Modulated Arc Therapy, Dynamic Multileaf Collimator Plans based on Linear Accelerator

A Dosimetric Comparison of Stereotactic Body Radiation Therapy for Lung Tumors: Plans of Gamma Knife, and Volumetric Modulated Arc Therapy, Dynamic Multileaf Collimator Plans based on Linear Accelerator

Dosimetric Evaluation Study of 10-MV FFF Used in SBRT for Lung Tumours

Single isocenter versus dual isocenter treatment using flattening filter‐free and jaw‐tracking volumetrically modulated arc therapy for boot‐shaped lung cancer: Evaluation of dosimetric and feasibility

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