Stereotactic radiotherapy for peripheral lung tumors: A comparison of volumetric modulated arc therapy with 3 other delivery techniques

The flattening filter free (FFF) X‐rays can provide much higher dose rate at the treatment target compared to the conventional flattened X‐rays. However, the substantial increase of dose rate for FFF beams may affect the ion recombination correction factor, which is required for accurate measurements using ionization chambers in clinical dosimetry. The purpose of this work is to investigate the ion recombination of three types of commonly used ion chambers (Farmer, PinPoint and plane‐parallel) in the FFF photon radiation. Both 6 MV and 10 MV flattened and FFF beams were fully commissioned on a Varian TrueBeam linear accelerator. The ion recombination correction factor, normalPion, was determined using the two‐voltage technique for a 0.6 cc Farmer chamber, a 0.015 cc PinPoint chamber, and a 0.02 cc parallel‐plate chamber at different source‐to‐axis distances (SAD) in a solid water phantom or water tank phantom at a depth of 10 cm in a 10×10 cm2 field. Good repeatability of measurements was demonstrated. Less than 1% difference in Pion between the flattened and FFF photons for all three ion chambers was observed. At a SAD of 100 cm and a depth of 10 cm for a 10×10 cm2 field, normalPion for the Farmer chamber was 1.004 and 1.008 for the 6 MV flattened and FFF beams, respectively. At the same setup using the Farmer chamber, normalPion was 1.002 and 1.015 for the 10 MV flattened and FFF beams, respectively. All normalPion results for the Farmer, PinPoint, or parallel plate chamber in the 6 MV and 10 MV flattened and FFF beams were within 2% from the unity (1 ≤ normalPion < 1.02). The normalPion ratio of the FFF to flattened beams was 0.99~1.01 for both 6 MV and 10 MV photons. The ion recombination effect of the Farmer, PinPoint, and plane‐parallel chamber in the FFF beams is not substantially different from that in the conventional flattened beams.PACS number: 87.56.bd

Section: Introductionmentioning

confidence: 99%

Ion recombination corrections of ionization chambers in flattening filter‐free photon radiation

Wang¹,

Easterling²,

Ting³

2012

“…Several groups have shown the efficacy of lung SBRT, using a combination of different immobilization and planning techniques, including static field techniques such as 3D conformal and intensity‐modulated radiotherapy (IMRT), as well as rotational techniques such as dynamic conformal arc and volumetric‐arc radiotherapy (VMAT). Each technique has its own advantages and disadvantages; 4 , 5 , 6 however, all of these planning techniques require skill and experience in order to create an optimal plan that achieves tumor conformity and geometric organ sparing.…”

Section: Introductionmentioning

confidence: 99%

Development and evaluation of a clinical model for lung cancer patients using stereotactic body radiotherapy (SBRT) within a knowledge‐based algorithm for treatment planning

Snyder

Kim

Reding

et al. 2016

The purpose of this study was to describe the development of a clinical model for lung cancer patients treated with stereotactic body radiotherapy (SBRT) within a knowledge‐based algorithm for treatment planning, and to evaluate the model performance and applicability to different planning techniques, tumor locations, and beam arrangements. 105 SBRT plans for lung cancer patients previously treated at our institution were included in the development of the knowledge‐based model (KBM). The KBM was trained with a combination of IMRT, VMAT, and 3D CRT techniques. Model performance was validated with 25 cases, for both IMRT and VMAT. The full KBM encompassed lesions located centrally vs. peripherally (43:62), upper vs. lower (62:43), and anterior vs. posterior (60:45). Four separate sub‐KBMs were created based on tumor location. Results were compared with the full KBM to evaluate its robustness. Beam templates were used in conjunction with the optimizer to evaluate the model's ability to handle suboptimal beam placements. Dose differences to organs‐at‐risk (OAR) were evaluated between the plans generated by each KBM. Knowledge‐based plans (KBPs) were comparable to clinical plans with respect to target conformity and OAR doses. The KBPs resulted in a lower maximum spinal cord dose by 1.0±1.6Gy compared to clinical plans, p=0.007. Sub‐KBMs split according to tumor location did not produce significantly better DVH estimates compared to the full KBM. For central lesions, compared to the full KBM, the peripheral sub‐KBM resulted in lower dose to 0.035 cc and 5 cc of the esophagus, both by 0.4Gy±0.8Gy, p=0.025. For all lesions, compared to the full KBM, the posterior sub‐KBM resulted in higher dose to 0.035 cc, 0.35 cc, and 1.2 cc of the spinal cord by 0.2±0.4Gy, p=0.01. Plans using template beam arrangements met target and OAR criteria, with an increase noted in maximum heart dose (1.2±2.2Gy, p=0.01) and GI (0.2±0.4, p=0.01) for the nine‐field plans relative to KBPs planned with custom beam angles. A knowledge‐based model for lung SBRT consisting of multiple treatment modalities and lesion locations produced comparable plan quality to clinical plans. With proper training and validation, a robust KBM can be created that encompasses both IMRT and VMAT techniques, as well as different lesion locations.PACS number(s): 87.55de, 87.55kh, 87.53Ly

“…Dynamic conformal arc therapy (DCAT) technique has been implemented in linear accelerator (linac) based stereotactic body radiotherapy (SBRT) for patients with Stage I/II non‐small‐cell lung cancer (NSCLC) 1, 2, 3, 4, 5, 6, 7, 8, 9. One advantage of DCAT technique is the robust and transferable treatment methodology in planning, which is capable of reproducing the same or similar optimized planning results on different planning systems 7, 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

“…One advantage of DCAT technique is the robust and transferable treatment methodology in planning, which is capable of reproducing the same or similar optimized planning results on different planning systems 7, 8, 9, 10. Compared to three‐dimensional (3D) conformal radiation therapy (3DCRT), DCAT has been proven to achieve higher target dose conformity and normal tissue dose sparing as well as shorter beam‐on time for dose delivery 9, 10. Rauschenbach et al10 stated that DCAT should remain an alternative to 3DCRT in facilities that do not have VMAT or IMRT.…”

Section: Introductionmentioning

confidence: 99%

Effects of collimator angle, couch angle, and starting phase on motion‐tracking dynamic conformal arc therapy (4D DCAT)

Yao

Podgorsak

et al. 2017

PurposeThe aim of this study was to find an optimized configuration of collimator angle, couch angle, and starting tracking phase to improve the delivery performance in terms of MLC position errors, maximal MLC leaf speed, and total beam‐on time of DCAT plans with motion tracking (4D DCAT).Method and materialsNontracking conformal arc plans were first created based on a single phase (maximal exhalation phase) of a respiratory motion phantom with a spherical target. An ideal model was used to simulate the target motion in superior‐inferior (SI), anterior‐posterior (AP), and left‐right (LR) dimensions. The motion was decomposed to the MLC leaf position coordinates for motion compensation and generating 4D DCAT plans. The plans were studied with collimator angle ranged from 0° to 90°; couch angle ranged from 350°(−10°) to 10°; and starting tracking phases at maximal inhalation (θ=π/2) and exhalation (θ=0) phases. Plan performance score (PPS) evaluates the plan complexity including the variability in MLC leaf positions, degree of irregularity in field shape and area. PPS ranges from 0 to 1, where low PPS indicates a plan with high complexity. The 4D DCAT plans with the maximal and the minimal PPS were selected and delivered on a Varian TrueBeam linear accelerator. Gafchromic‐EBT3 dosimetry films were used to measure the dose delivered to the target in the phantom. Gamma analysis for film measurements with 90% passing rate threshold using 3%/3 mm criteria and trajectory log files were analyzed for plan delivery accuracy evaluation.ResultsThe maximal PPS of all the plans was 0.554, achieved with collimator angle at 87°, couch angle at 350°, and starting phase at maximal inhalation (θ=π/2). The maximal MLC leaf speed, MLC leaf errors, total leaf travel distance, and beam‐on time were 20 mm/s, 0.39 ± 0.16 mm, 1385 cm, and 157 s, respectively. The starting phase, whether at maximal inhalation or exhalation had a relatively small contribution to PPS (0.01 ± 0.05).ConclusionsBy selecting collimator angle, couch angle, and starting tracking phase, 4D DCAT plans with the maximal PPS demonstrated less MLC leaf position errors, lower maximal MLC leaf speed, and shorter beam‐on time which improved the performance of 4D motion‐tracking DCAT delivery.