Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

Mallory, Matthew; Pokhrel, Damodar; Badkul, R.K.; Jiang, Hongyu; Lominska, Chris; Wang, Fen

doi:10.1002/acm2.12252

Cited by 9 publications

(3 citation statements)

References 36 publications

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“…Just as Steven et al [8] concluded, IMRT techniques, by virtue of a greater dose conformity, are potentially able to reduce toxicity to OARs but not to improve survival outcomes [22]. These techniques have already been effectively tested in other clinical scenarios demanding a significant sparing of some OARs, e.g., spinal cord or urethra, similarly located within a surrounding radiotherapy target [23][24][25], or for reirradiation [26]. We know that other radiotherapy techniques are equally effective in the treatment of cutaneous targets [27][28][29][30], but their use is less suitable for highly complex clinical situations such as the present one.…”

Section: Discussionmentioning

confidence: 99%

Volumetric Modulated Arc Therapy Capabilities for Treating Lower-Extremity Skin Affected by Several Merkel Cell Carcinoma Nodules: When Technological Advances Effectively Achieve the Palliative Therapeutic Goal while Minimising the Risk of Potential Toxicities

Ferini¹,

Valenti²,

Puliafito³

et al. 2021

Medicina

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The peculiar and rare clinical condition below clearly requires a customized care approach in the context of personalized medicine. An 80-year-old female patient who was subjected in 2018 to surgical removal of a cutaneous Merkel cell carcinoma (MCC) nodule located on the posterior surface of the left thigh and to three subsequent palliative radiotherapy treatments developed a fourth relapse in October 2020, with fifteen nodular metastases located in the left thigh and leg. Since the overall macroscopic disease was still exclusively regionally located and microscopic spread was likely extended also to clinically negative skin of the thigh and leg, we performed an irradiation of the whole left lower extremity. For this purpose the total target (65.5 cm) was divided into three sub-volumes. Dose prescription was 30 Gy in 15 daily fractions. A sequential boost of 10 Gy in 5 daily fractions was planned for macroscopic nodules. Plans were calculated by means of volumetric modulated arc therapy (VMAT) with the field overlap technique. Thanks to this, we obtained a homogeneous dose distribution in the field junction region; avoidance structures were delineated in the central part of the thigh and leg with the aim of achieving an optimal superficial dose painting and to reduce bone exposure to radiation. This case study demonstrates that VMAT allows for a good dose coverage for circumferential cutaneous targets while sparing deeper organs at risk. A reproducible image-guided set-up is fundamental for an accurate and safe dose delivery. However, local treatments such as radiotherapy for very advanced MCC of the lower extremities might have limited impact due to the high probability of systemic progression, as illustrated in this case. Radiation is confirmed as being effective in preventing MCC nodule progression toward skin wounding.

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Section: Discussionmentioning

confidence: 99%

Volumetric Modulated Arc Therapy Capabilities for Treating Lower-Extremity Skin Affected by Several Merkel Cell Carcinoma Nodules: When Technological Advances Effectively Achieve the Palliative Therapeutic Goal while Minimising the Risk of Potential Toxicities

Ferini¹,

Valenti²,

Puliafito³

et al. 2021

Medicina

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“…It has not been the purpose of this study to compare VMAT with other treatment techniques. However, several previous studies have reported significantly shorter beam-on times using VMAT compared to other techniques such as static intensity modulated radiotherapy (IMRT) [25] , [26] , [27] , [28] . The use of VMAT and FFF-beams is an ideal combination to obtain very short beam-on times and minimize the risk of unwanted patient movements.…”

Section: Discussionmentioning

confidence: 99%

Intrafractional motion in stereotactic body radiotherapy of spinal metastases utilizing cone beam computed tomography image guidance

Svestad

Ramberg

Skår

et al. 2019

Physics and Imaging in Radiation Oncology

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Background and purpose: Spine stereotactic body radiotherapy (SBRT) requires a high degree of accuracy due to steep dose gradients close to the spinal cord. This study aimed to (1) evaluate intrafractional motion in spine SBRT utilizing flattening filter free (FFF) beam delivery and cone beam computed tomography (CBCT) image guidance and (2) evaluate if adding another CBCT acquisition and corrections prior to treatment improves the overall position accuracy. Materials and methods: Intrafractional motion was retrospectively analyzed for 78 fractions in 54 patients. All patients were immobilized with an evacuated cushion. Before treatment, a CBCT was acquired, a bony fusion with the planning CT was performed and translational and rotational errors were corrected. For 30 of the patients (39 fractions) acquisition of another CBCT and corrections were performed before treatment. A post treatment CBCT was acquired for all patients, and translational and rotational errors measured by fusion of the post treatment CBCT with the planning CT were recorded to calculate means and standard deviations (SDs). Results: The positional errors were significantly smaller in 4 out of 6 error values in the patient group treated with verification CBCT. In this group, translational and rotational SDs ranged from 0.5 to 0.6 mm and 0.3°, respectively. Corresponding values in the group treated without verification CBCT were 0.7-1.0 mm and 0.4-0.7°. Conclusion: With proper CBCT image guidance, patient immobilization and FFF-beam delivery, one can obtain very high patient position accuracy in spine SBRT. Inclusion of a verification CBCT prior to treatment increases the overall position accuracy.

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“…Introduction of high-dose treatments like stereotactic body radiation therapy (SBRT) [8] raises the important questions about the updated role of RT in MM management. Although increasingly effective [9], some reports highlight that modern radiation techniques, like VMAT (volumetric modulated arc therapy), can increase the risk of lymphopenia by irradiating large volumes of tissue with low doses of radiation [10]. Cytopenias, including neutropenia, have been associated with worse outcomes in MM [11].…”

Section: Introductionmentioning

confidence: 99%

Predicting neutropenia dynamics after radiation therapy in multiple myeloma patients receiving first-line bortezomib-based chemotherapy – a pilot study

Masłowski,

Stawiski,

Zięba

et al. 2023

Nowotwory. Journal of Oncology

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Introduction. Radiation therapy (RT) is a useful modality for achieving local control and symptom relief in patients with multiple myeloma (MM), but its use can result in adverse effects such as neutropenia, which may be aggravated by prior chemotherapy. Material and methods. In this retrospective study, we analyzed 530 complete blood count results of 32 MM patients who underwent RT for symptomatic bone pain between cycles or after completing first-line bortezomib-based chemotherapy (VCD). To evaluate the dynamics of neutrophil count (ANC) changes, we developed a generalized additive model (GAM) using initial ANC, dosage (BED10), and treatment volume (PTV) as predictors.Results. Our GAM model demonstrated that ANC nadir after RT can be expected approximately 16 days after treatment initiation. The delivery of 8 Gy in 1 fraction resulted in the lowest ANC nadir, while a dose of 30 Gy in 10-15 fractions was deemed the safest. For PTV = 1000 cm 3 , an initial ANC level of at least 1.42 × 10 3 /µl was associated with no incidence of severe neutropenia irrespective of the fractionation scheme. Longer courses allowed for treatment delivery without significant neutropenia even with an initial ANC of 1.23 × 10 3 /µl on the day of RT initiation. Conclusions. Our model could aid in optimizing treatment strategies for MM patients receiving RT and chemotherapy. Further research is needed to validate our findings and evaluate the feasibility of implementing this model in clinical practice.

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Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

Cited by 9 publications

References 36 publications

Volumetric Modulated Arc Therapy Capabilities for Treating Lower-Extremity Skin Affected by Several Merkel Cell Carcinoma Nodules: When Technological Advances Effectively Achieve the Palliative Therapeutic Goal while Minimising the Risk of Potential Toxicities

Volumetric Modulated Arc Therapy Capabilities for Treating Lower-Extremity Skin Affected by Several Merkel Cell Carcinoma Nodules: When Technological Advances Effectively Achieve the Palliative Therapeutic Goal while Minimising the Risk of Potential Toxicities

Intrafractional motion in stereotactic body radiotherapy of spinal metastases utilizing cone beam computed tomography image guidance

Predicting neutropenia dynamics after radiation therapy in multiple myeloma patients receiving first-line bortezomib-based chemotherapy – a pilot study

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