No differences in radiological changes after 3D conformal vs VMAT-based stereotactic radiotherapy for early stage non-small cell lung cancer

Badellino, Serena; Muzio, J. Di; Schivazappa, Giulia; Guarneri, Alessia; Ragona, Riccardo; Bartoncini, Sara; Trino, Elisabetta; Filippi, Andrea Riccardo; Fonio, Paolo; Ricardi, Umberto

doi:10.1259/bjr.20170143

Cited by 13 publications

(10 citation statements)

References 18 publications

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“…A Dutch series aiming to compare clinical and radiographic rates of pneumonitis between 3DCRT and VMAT did not uncover differences in early follow-up 19. A similar analysis focused on radiographic changes following SBRT of either 3DCRT or VMAT likewise was not able to appreciate a difference after a median follow up of 20.5 months 20…”

Section: Discussionmentioning

confidence: 92%

Outcomes Following Stereotactic Body Radiotherapy with Intensity-Modulated Therapy versus Three-Dimensional Conformal Radiotherapy in Early Stage Non-Small Cell Lung Cancer

Mix

Tanny

Nsouli

et al. 2019

LCTT

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IntroductionThe treatment techniques used for stereotactic body radiation therapy (SBRT) for early-stage lung cancer continue to evolve. In this study, clinical outcomes following SBRT were evaluated according to the use of either 3D conformal radiotherapy (3DCRT) or intensity-modulated radiation therapy (IMRT).Patients and methodsPatients with stage I NSCLC who received SBRT from 2007 to 2015 were retrospectively reviewed. Disease control and survival were assessed using Kaplan-Meier estimates. Dosimetric analyses for target dose heterogeneity and coverage were performed.ResultsA total of 297 patients with 351 lesions were included. 3DCRT was used in 52% and IMRT in 48%. IMRT was utilized at a higher rate in more recent years. The most common regimens were 48 Gy in 4 fractions and 54–60 Gy in 3 fractions. With a median follow up of 22.7 months, there were 17 local failures for a crude relapse rate of 5.7%. Local failure did not differ in patients treated with 3DCRT and IMRT (4.9% vs 6.5%, p=0.573). Mean dose to gross tumor volume (GTV) as a percent of prescription dose was higher with 3DCRT compared with IMRT (107.7% vs 103.6%, p < 0.0001). Tumor stage, histology, and SBRT regimen did not correlate with local tumor control. Overall survival for the entire population approximated 72% at 2 years. Treatment was well tolerated with 6 documented grade 3+ events.ConclusionIn this single-institution cohort of SBRT for early-stage NSCLC, there was no discernible difference in clinical outcomes between those treated with 3DCRT and IMRT.

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Section: Discussionmentioning

confidence: 92%

Outcomes Following Stereotactic Body Radiotherapy with Intensity-Modulated Therapy versus Three-Dimensional Conformal Radiotherapy in Early Stage Non-Small Cell Lung Cancer

Mix

Tanny

Nsouli

et al. 2019

LCTT

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“…Previous reports showed that the V 5 of the lungs is unlikely to affect the grade of radiation pneumonitis. [ 39 40 ] V 20 is a more well-known risk factor for symptomatic radiation pneumonitis than V 5 . [ 41 ] The KBPs generated lower V 20 than the CLPs in both the closed- and open-loop validations, although there was no significant difference.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Evaluation of Simplified Knowledge-Based Plan with an Extensive Stepping Validation Approach in Volumetric-Modulated Arc Therapy-Stereotactic Body Radiotherapy for Lung Cancer

Wada

Monzen

Tamura

et al. 2021

Journal of Medical Physics

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Purpose: We investigated the performance of the simplified knowledge-based plans (KBPs) in stereotactic body radiotherapy (SBRT) with volumetric-modulated arc therapy (VMAT) for lung cancer. Materials and Methods: For 50 cases who underwent SBRT, only three structures were registered into knowledge-based model: total lung, spinal cord, and planning target volume. We performed single auto-optimization on VMAT plans in two steps: 19 cases used for the model training (closed-loop validation) and 16 new cases outside of training set (open-loop validation) for TrueBeam (TB) and Halcyon (Hal) linacs. The dosimetric parameters were compared between clinical plans (CLPs) and KBPs: CLPclosed, KBPclosed-TB and KBPclosed-Hal in closed-loop validation, CLPopen, KBPopen-TB and KBPopen-Hal in open-loop validation. Results: All organs at risk were comparable between CLPs and KBPs except for contralateral lung: V5 of KBPs was approximately 3%–7% higher than that of CLPs. V20 of total lung for KBPs showed comparable to CLPs; CLPclosed vs. KBPclosed-TB and CLPclosed vs. KBPclosed-Hal: 4.36% ± 2.87% vs. 3.54% ± 1.95% and 4.36 ± 2.87% vs. 3.54% ± 1.94% (P = 0.54 and 0.54); CLPopen vs. KBPopen-TB and CLPopen vs. KBPopen-Hal: 4.18% ± 1.57% vs. 3.55% ± 1.27% and 4.18% ± 1.57% vs. 3.67% ± 1.26% (P = 0.19 and 0.27). CI95 of KBPs with both linacs was superior to that of the CLP in closed-loop validation: CLPclosed vs. KBPclosed-TB vs. KBPclosed-Hal: 1.32% ± 0.12% vs. 1.18% ± 0.09% vs. 1.17% ± 0.06% (P < 0.01); and open-loop validation: CLPopen vs. KBPopen-TB vs. KBPopen-Hal: 1.22% ± 0.09% vs. 1.14% ± 0.04% vs. 1.16% ± 0.05% (P ≤ 0.01). Conclusions: The simplified KBPs with limited number of structures and without planner intervention were clinically acceptable in the dosimetric parameters for lung VMAT-SBRT planning.

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“…With respect to radiological changes after lung SBRT, Badellino et al reported that late changes occurred in approximately 60% of patients treated with 3D-CRT and VMAT without differences between the two techniques in radiological patterns. 8 To date, there is little information on the functions of these high-dose regions inside and outside the PTV as a normal lung after tumor control in patients without late fibrotic changes and the contributions of these regions to RP risk. However, our findings showing increasing differences between the 3D-CRT and IMRT plans in high-dose parameters, including the V48 and V50, according to increasing PTV need to be considered in relation to the potential clinical significance of the high-dose region and tumor characteristics in lung SBRT.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] Furthermore, some studies have recently compared the differences in radiological changes after lung SBRT using two different techniques with differences in dose distributions. 7,8 Regarding toxic effects of lung SBRT, radiation pneumonitis (RP) is one of the most commonly studied toxic effects, with reported symptomatic RP rates ranging from 9% to 28%. 9 Together with clinical risk factors for RP, dosimetric factors, such as the mean lung dose (MLD) and the percentage of total lung volume receiving a specific dose, have been used to guide the dose limit in RT planning for lung cancer to prevent RP.…”

Section: Introductionmentioning

confidence: 99%

Impact of tumor size and location on lung dose difference between stereotactic body radiation therapy techniques for non‐small cell lung cancer

et al. 2021

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Background: To evaluate the lung dose differences between three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) techniques for lung stereotactic body radiation therapy (SBRT) and the correlations with tumor characteristics, such as size and location. Methods: Dosimetric comparisons between the two SBRT techniques in high-and low-to intermediate-dose regions were retrospectively performed using four planning indices and lung-dose parameters in 31 lung tumors. The magnitude of differences in these parameters was analyzed with relation to the planning target volume (PTV) and location-related parameters. Results: The absolute differences between the two techniques in lung-dose parameters were small in both ipsilateral and bilateral lungs. The dosimetric differences were mainly correlated with the PTV rather than location-related parameters, with positive and negative correlations with the high-dose and intermediate-dose parameters, respectively. The distances from the ipsilateral lung centroid to the PTV center were not correlated with the differences in any of the lung-dose parameters. Additionally, the negative correlations with the MLD and V20 differences disappeared after applying a more rapid dose fall-off in the IMRT plans for tumors with small PTVs of ≤15 cc. Conclusions: Lung dose differences between the 3D-CRT and IMRT techniques for lung SBRT were mainly correlated with the PTV rather than location-related parameters. Together with the dosimetric benefit in high-dose lung regions of IMRT for larger tumors, the relative increases in the MLD and V20 for small-sized tumors could be reduced by applying a more rapid dose fall-off outside the PTV.

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No differences in radiological changes after 3D conformal vs VMAT-based stereotactic radiotherapy for early stage non-small cell lung cancer

Cited by 13 publications

References 18 publications

<p>Outcomes Following Stereotactic Body Radiotherapy with Intensity-Modulated Therapy versus Three-Dimensional Conformal Radiotherapy in Early Stage Non-Small Cell Lung Cancer</p>

<p>Outcomes Following Stereotactic Body Radiotherapy with Intensity-Modulated Therapy versus Three-Dimensional Conformal Radiotherapy in Early Stage Non-Small Cell Lung Cancer</p>

Dosimetric Evaluation of Simplified Knowledge-Based Plan with an Extensive Stepping Validation Approach in Volumetric-Modulated Arc Therapy-Stereotactic Body Radiotherapy for Lung Cancer

Impact of tumor size and location on lung dose difference between stereotactic body radiation therapy techniques for non‐small cell lung cancer

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