Prostate Stereotactic Body Radiation Therapy With Halcyon 2.0: Treatment Plans Comparison Based on RTOG 0938 Protocol

Altundal, Y; Cifter, F; Mu, G; Lee, James; Wu, Elisa; Yeung, Vincent; Katz, Alan J.

doi:10.7759/cureus.11660

Cited by 4 publications

(9 citation statements)

References 25 publications

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“…However, so far no clinical manifestations of such small bowel toxicity have been observed in treated patients. In addition, Halcyon plans showed a better sparing of the skin than CK plans in agreement with the reported outcome in prostate treatments by Altundal et al 17 The DVH comparison (Figures 5 and 6) demonstrate that there are no major differences in the dose to OARs in CK and Halcyon plans both above and below optimal PTV volume threshold, however the doses to the targets are distinguishable for both plans. This outcome is due to, on one hand, the difference in the dose prescription isodose and on the other hand, to differences in conformity between treatment plan groups.…”

Section: Discussionsupporting

confidence: 88%

Quality assessment of automatically planned O‐Ring linac SBRT plans for pelvic lymph node metastases, finding the optimal minimum target size by comparison with robotic SBRT

Hernández,

Unterkirhers,

Schneider

2023

J Applied Clin Med Phys

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PurposeThe purpose of this study is to assess the quality of automatic planned O‐Ring Halcyon linac SBRT plans for pelvic lymph node metastases and to establish an absolute PTV volume threshold as a plan quality prediction criterion. Compliance of the plans to institutional SBRT plan evaluation criteria and differences in plan quality and treatment delivery times between Halcyon Linac and CyberKnife robotic SBRT were evaluated.MethodsTwenty‐one CyberKnife treatment plans were replanned for Halcyon. Prescription doses range was 26–40 Gy in mean three fractions. The mean/median planning target volume was 4.0/3.6 cm3. Institutional criteria for the plan evaluation were: New Conformity Index (NCI), Conformity Index (CI), Modified Gradient Index (MGI), selectivity index reciprocal (PIV/TVPIV), and the target coverage by prescription isodose (%PIV). Statistical analysis based on the receiver operating characteristic (ROC) curve was used to determine a plan quality predictor threshold of the PTV volume. Comparative analysis of normal tissue complication probabilities (NTCP) was used to assess the risk of toxicity in healthy tissues.ResultsSeventy‐one percent (n = 15)/95% (n = 20) of Halcyon and 81% (n = 17)/100% (n = 21) of CK plans fulfilled all ideal/tolerance criteria. For PTVs above a found optimal threshold of 2.6 cm3 (71%, n = 15), no statistically significant difference was observed between the CI, NCI, PIV/TVPIV, and MGI indexes of both groups, while the coverage (%PIV) was statistically but not clinically significantly different between cohorts. Significantly shorter delivery times are expected with Halcyon. No significant differences in NTCP were observed.ConclusionAll but one automatically optimized Halcyon treatment plans demonstrated ideal or acceptable performance. PTV threshold of 2.6 cm3 can be used as decision criteria in clinical settings. The results of our study demonstrated the promising performance of the Halcyon for pelvic SBRT, although plan‐specific QA is required to verify machine performance during plan delivery.

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Section: Discussionsupporting

confidence: 88%

Quality assessment of automatically planned O‐Ring linac SBRT plans for pelvic lymph node metastases, finding the optimal minimum target size by comparison with robotic SBRT

Hernández,

Unterkirhers,

Schneider

2023

J Applied Clin Med Phys

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Section: Discussionsupporting

confidence: 82%

“…The data presented here demonstrate the ability of the new Halcyon linac to produce robust and reliable treatment plans for hypofractionated prostate radiotherapy and confirm earlier investigations for different cancer types and radiotherapy regimes. 16 , 17 , 18 , 19 , 20 , 21 The patient‐specific QA showed no statistically significant differences in diode array‐based gamma pass rate measurements between Synergy and Halcyon. Agreement between the measured and calculated dose was high for both linear accelerators with a maximum deviation of 1.7% and 2.3% in ion chamber point dose for Synergy and Halcyon, respectively.…”

Section: Discussionmentioning

confidence: 87%

Comparison of treatment plans for hypofractionated high‐dose prostate cancer radiotherapy using the Varian Halcyon and the Elekta Synergy platforms

Tamihardja

Razinskas

Exner

et al. 2021

J Applied Clin Med Phys

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Purpose To compare radiotherapy plans between an O‐ring and a conventional C‐arm linac for hypofractionated high‐dose prostate radiotherapy in terms of plan quality, dose distribution, and quality assurance in a multi‐vendor environment. Methods Twenty prostate cancer treatment plans were irradiated on the O‐ring Varian Halcyon linac and were re‐optimized for the C‐arm Elekta Synergy Agility linac. Dose‐volume histogram metrics for target coverage and organ at risk dose, quality assurance, and monitor units were retrospectively compared. Patient‐specific quality assurance with ion chamber measurements, gamma index analysis, and portal dosimetry was performed using the Varian Portal Dosimetry system and the ArcCHECK® phantom (Sun Nuclear Corporation). Prostate‐only radiotherapy was delivered with simultaneous integrated boost (SIB) volumetric modulated arc therapy (VMAT) in 20 fractions of 2.5/3.0 Gy each. Results For both linacs, target coverage was excellent and plan quality comparable. Homogeneity in PTVBoost was high for Synergy as well as Halcyon with a mean homogeneity index of 0.07 ± 0.01 and 0.05 ± 0.01, respectively. Mean dose for the organs at risk rectum and bladder differed not significantly between the linacs but were higher for the femoral heads and penile bulb for Halcyon. Quality assurance showed no significant differences in terms of ArcCHECK gamma pass rates. Median pass rate for 3%/2 mm was 99.3% (96.7 to 99.8%) for Synergy and 99.8% (95.6 to 100%) for Halcyon. Agreement between calculated and measured dose was high with a median deviation of −0.6% (−1.7 to 0.8%) for Synergy and 0.2% (−0.6 to 2.3%) for Halcyon. Monitor units were higher for the Halcyon by approximately 20% (p < 0.001). Conclusion Hypofractionated high‐dose prostate cancer SIB VMAT on the Halcyon system is feasible with comparable plan quality in reference to a standard C‐arm Elekta Synergy linac.

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“…Roover et al [33] compared the Halcyon 3-arc VMAT-SBRT plans with the TB 2-arc VMAT-SBRT plans in 20 prostate cancer cases and found that the Halcyon 3-arc plans showed higher planning target volume coverage (D 99% ) of the seminal vesicle, along with reduced high-dose spillage of the bladder (V 37Gy ) and urethral (D 0.035cc ). Altundal et al [34] compared 20 prostate patients’ SBRT plans of Halcyon 2.0 and CyberKnife and found that all Halcyon SBRT plans met the goals and constraints of the RTOG 0938 protocol, with improved CI and target dose coverage, reduced maximum dose in the skin and urethra compared to the CyberKnife plans. Comparison of Halcyon SRT plans with their counterparts in high-end devices such as TB led to the optimistic conclusion that the Halcyon VMAT-SRT plans were dosimetrically equivalent to TB plans, and can achieve better dosimetric performance for some treatment sites.…”

Section: Resultsmentioning

confidence: 99%

“…Based on 15 spine SBRT plans, Petroccia et al [17] found that the gamma passing rates for Halcyon 1.0 and 2.0 with 2%/2 mm criterion were 98.8 ± 0.2% and 96.9 ± 2.0%, respectively, and no statistical difference in gamma passing rates was observed between Halcyon and TB plans. Altundal et al [34] analyzed 15 prostate cancer patients and found that Halcyon plans' average gamma passing rate was 99.75 ± 0.08 with a 2%/2 mm criterion and a 10% threshold. With the same criterion, Roover et al [33] used portal dosimetry to collect the gamma passing rates of 20 prostate cancer patients of the TB HD-MLC VMAT-SBRT plans and the Halcyon VMAT-SBRT plans.…”

Section: Gamma Passing Ratesmentioning

confidence: 99%

Dosimetric performance evaluation of the Halcyon treatment platform for stereotactic radiotherapy: A pooled study

Huang,

Liu

2023

Medicine

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With the advancement of radiotherapy equipment, stereotactic radiotherapy (SRT) has been increasingly used. Among the many radiotherapy devices, Halcyon shows promising applications. This article reviews the dosimetric performance such as plan quality, plan complexity, and gamma passing rates of SRT plans with Halcyon to determine the effectiveness and safety of Halcyon SRT plans. This article retrieved the last 5 years of PubMed studies on the effectiveness and safety of the Halcyon SRT plans. Two authors independently reviewed the titles and abstracts to decide whether to include the studies. A search was conducted to identify publications relevant to evaluating the dosimetric performance of SRT plans on Halcyon using the key strings Halcyon, stereotactic radiosurgery, SRT, stereotactic body radiotherapy, and stereotactic ablative radiotherapy. A total of 18 eligible publications were retrieved. Compared to SRT plans on the TrueBeam, the Halcyon has advantages in terms of plan quality, plan complexity, and gamma passing rates. The high treatment speed of SRT plans on the Halcyon is impressive, while the results of its plan evaluation are also encouraging. As a result, Halcyon offers a new option for busy radiotherapy units while significantly improving patient comfort in treatment. For more accurate results, additional relevant publications will need to be followed up in subsequent studies.

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Prostate Stereotactic Body Radiation Therapy With Halcyon 2.0: Treatment Plans Comparison Based on RTOG 0938 Protocol

Cited by 4 publications

References 25 publications

Quality assessment of automatically planned O‐Ring linac SBRT plans for pelvic lymph node metastases, finding the optimal minimum target size by comparison with robotic SBRT

Quality assessment of automatically planned O‐Ring linac SBRT plans for pelvic lymph node metastases, finding the optimal minimum target size by comparison with robotic SBRT

Comparison of treatment plans for hypofractionated high‐dose prostate cancer radiotherapy using the Varian Halcyon and the Elekta Synergy platforms

Dosimetric performance evaluation of the Halcyon treatment platform for stereotactic radiotherapy: A pooled study

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