External beam pulsed low dose radiotherapy using volumetric modulated arc therapy: Planning and delivery

Tyagi, Neelam; Yang, Kai; Sandhu, R; Yan, Di; Park, Sean S.; Chen, Peter Y.; Marples, Brian

doi:10.1118/1.4769119

Cited by 9 publications

(15 citation statements)

References 32 publications

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“…The data showing ECRR1 staining in tumor sections (Figure 4B) were not conclusive, and future studies are being planned to determine the absolute delivery of CDDP to irradiated tumors using atomic absorption spectrophotometry(39,40).Previously published studies using PRT for recurrent glioblastoma have demonstrated that PRT is clinically feasible, and patients have tolerated PRT treatment well(11). Volumetric modulated arc radiotherapy (VMAT) reduces treatment delivery time significantly and a PRT plan can be delivered in approximately 50 minutes(42). However, this length of treatment may still represent a challenge for head and neck patients as they near the completion of their treatment when the…”

mentioning

confidence: 97%

Pulsed Radiation Therapy With Concurrent Cisplatin Results in Superior Tumor Growth Delay in a Head and Neck Squamous Cell Carcinoma Murine Model

Meyer

Krueger

Kane

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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mentioning

confidence: 97%

Pulsed Radiation Therapy With Concurrent Cisplatin Results in Superior Tumor Growth Delay in a Head and Neck Squamous Cell Carcinoma Murine Model

Meyer

Krueger

Kane

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…Intensity‐modulated arc therapy is a desirable alternative to 3D CRT for LDR irradiation, offering the advantages of a uniform dose to the PTV per 20 cGy field and improved PTV conformity; Tyagi et al (13) have reported on VMAT planning and delivery of LDR brain cases using the Pinnacle 3 treatment planning system (Philips Radiation Oncology Systems, Fitchburg, WI) and Elekta linear accelerators (Elekta, Inc., Crawley, UK). At our institution to‐date, mARC has been used to administer a low‐dose‐rate (LDR) treatment to 17 patients.…”

Section: Methodsmentioning

confidence: 99%

Clinical experience with planning, quality assurance, and delivery of burst‐mode modulated arc therapy

Kainz

Prah

Ahunbay

et al. 2016

J Applied Clin Med Phys

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“Burst‐mode” modulated arc therapy (hereafter referred to as “mARC”) is a form of volumetric‐modulated arc therapy characterized by variable gantry rotation speed, static MLCs while the radiation beam is on, and MLC repositioning while the beam is off. We present our clinical experience with the planning techniques and plan quality assurance measurements of mARC delivery. Clinical mARC plans for five representative cases (prostate, low‐dose‐rate brain, brain with partial‐arc vertex fields, pancreas, and liver SBRT) were generated using a Monte Carlo–based treatment planning system. A conventional‐dose‐rate flat 6 MV and a high‐dose‐rate non‐flat 7 MV beam are available for planning and delivery. mARC plans for intact‐prostate cases can typically be created using one 360° arc, and treatment times per fraction seldom exceed 6 min using the flat beam; using the nonflat beam results in slightly higher MU per fraction, but also in delivery times less than 4 min and with reduced mean dose to distal organs at risk. mARC also has utility in low‐dose‐rate brain irradiation; mARC fields can be designed which deliver a uniform 20 cGy dose to the PTV in approximately 3‐minute intervals, making it a viable alternative to conventional 3D CRT. For brain cases using noncoplanar arcs, delivery time is approximately six min using the nonflat beam. For pancreas cases using the nonflat beam, two overlapping 360° arcs are required, and delivery times are approximately 10 min. For liver SBRT, the time to deliver 800 cGy per fraction is at least 12 min. Plan QA measurements indicate that the mARC delivery is consistent with the plan calculation for all cases. mARC has been incorporated into routine practice within our clinic; currently, on average approximately 15 patients per day are treated using mARC; and with the exception of LDR brain cases, all are treated using the nonflat beam.PACS number(s): 87.55.D‐, 87.55.K‐, 87.53.Ay. 87.56.N‐

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“…It has been reported that it is possible to use one or two intensity‐modulated arcs to deliver PLDR plans to achieve better target coverage and normal tissue sparing for treatment of complex tumors (9‐11) . The PLDR treatment of recurrent cancers using dynamic arc therapy delivers 0.2 Gy to the target per arc with a 3 min interval.…”

Section: Introductionmentioning

confidence: 99%

“…Rong et al (10) demonstrated that with special machine parameters, a tomotherapy plan could be delivered within the 3 min time interval to meet the PLDR treatment requirement with a 3 min interval between fields. Tyagi et al (11) showed that previously treated glioblastoma multiforme (GBM) cases could be replanned using volumetric‐modulated arc therapy (VMAT) with a single 160° arc to deliver 0.2 Gy pulses on the new Elekta accelerator (Elekta AB, Stockholm, Sweden). Ma et al (9) implemented the PLDR technique using the Varian RapidArc technique (Varian Medical Systems, Palo Alto, CA).…”

Section: Introductionmentioning

confidence: 99%

Optimization strategies for pulsed low‐dose‐rate IMRT of recurrent lung and head and neck cancers

Kang

Lang

Wang

et al. 2014

J Applied Clin Med Phys

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Pulsed low‐dose‐rate radiotherapy (PLDR) has been proven to be a valid method of reirradiation. Previous studies of recurrent cancer radiotherapy were mainly based on conventional 3D CRT and VMAT delivery techniques. There are difficulties in IMRT planning using existing commercial treatment planning systems (TPS) to meet the PLDR protocol. This work focuses on PLDR using ten‐field IMRT and a commercial TPS for two specific sites: recurrent lung cancers and head and neck cancers. Our PLDR protocol requires that the maximum dose to the PTV be less than 0.4 Gy and the mean dose to be 0.2 Gy per field. We investigated various planning strategies to meet the PLDR requirements for 20 lung and head and neck patients. The PTV volume for lung cases ranged from 101.7 to 919.4 cm3 and the maximum dose to the PTV ranged from 0.22 to 0.39 Gy. The PTV volume for head and neck cases ranged from 66.2 to 282.1 cm3 and the maximum dose to the PTV ranged from 0.21 to 0.39 Gy. With special beam arrangements and dosimetry parameters, it is feasible to use a commercial TPS to generate quality PLDR IMRT plans for lung and head and neck reirradiation.PACS number: 87.55.D‐

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External beam pulsed low dose radiotherapy using volumetric modulated arc therapy: Planning and delivery

Abstract: Elekta linacs are capable of delivering reproducible and stable PLRT plans. A prospective clinical study employing PLRT is currently in development.

Cited by 9 publications

References 32 publications

Pulsed Radiation Therapy With Concurrent Cisplatin Results in Superior Tumor Growth Delay in a Head and Neck Squamous Cell Carcinoma Murine Model

Pulsed Radiation Therapy With Concurrent Cisplatin Results in Superior Tumor Growth Delay in a Head and Neck Squamous Cell Carcinoma Murine Model

Clinical experience with planning, quality assurance, and delivery of burst‐mode modulated arc therapy

Optimization strategies for pulsed low‐dose‐rate IMRT of recurrent lung and head and neck cancers

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