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Title: Potential for dose-escalation and reduction of risk in pancreatic cancer using IMRT optimization with lexicographic ordering and gEUD-based cost functions

Abstract

Radiotherapy for pancreatic cancer is limited by the tolerance of local organs at risk (OARs) and frequent overlap of the planning target volume (PTV) and OAR volumes. Using lexicographic ordering (LO), a hierarchical optimization technique, with generalized equivalent uniform dose (gEUD) cost functions, we studied the potential of intensity modulated radiation therapy (IMRT) to increase the dose to pancreatic tumors and to areas of vascular involvement that preclude surgical resection [surgical boost volume (SBV)]. We compared 15 forward planned three-dimensional conformal (3DCRT) and IMRT treatment plans for locally advanced unresectable pancreatic cancer. We created IMRT plans optimized using LO with gEUD-based cost functions that account for the contribution of each part of the resulting inhomogeneous dose distribution. LO-IMRT plans allowed substantial PTV dose escalation compared with 3DCRT; median increase from 52 Gy to 66 Gy (a=-5,p<0.005) and median increase from 50 Gy to 59 Gy (a=-15,p<0.005). LO-IMRT also allowed increases to 85 Gy in the SBV, regardless of a value, along with significant dose reductions in OARs. We conclude that LO-IMRT with gEUD cost functions could allow dose escalation in pancreas tumors with concomitant reduction in doses to organs at risk as compared with traditional 3DCRT.

Authors:
; ; ; ; ; ; ; ;  [1]
  1. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48109-0010 (United States)
Publication Date:
OSTI Identifier:
20951046
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 34; Journal Issue: 2; Other Information: DOI: 10.1118/1.2426403; (c) 2007 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COST; DOSIMETRY; HEALTH HAZARDS; NEOPLASMS; OPTIMIZATION; PANCREAS; PLANNING; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY; SURGERY

Citation Formats

Spalding, Aaron C., Jee, Kyung-Wook, Vineberg, Karen, Jablonowski, Marla, Fraass, Benedick A., Pan, Charlie C., Lawrence, Theodore S., Ten Haken, Randall K., and Ben-Josef, Edgar. Potential for dose-escalation and reduction of risk in pancreatic cancer using IMRT optimization with lexicographic ordering and gEUD-based cost functions. United States: N. p., 2007. Web. doi:10.1118/1.2426403.
Spalding, Aaron C., Jee, Kyung-Wook, Vineberg, Karen, Jablonowski, Marla, Fraass, Benedick A., Pan, Charlie C., Lawrence, Theodore S., Ten Haken, Randall K., & Ben-Josef, Edgar. Potential for dose-escalation and reduction of risk in pancreatic cancer using IMRT optimization with lexicographic ordering and gEUD-based cost functions. United States. doi:10.1118/1.2426403.
Spalding, Aaron C., Jee, Kyung-Wook, Vineberg, Karen, Jablonowski, Marla, Fraass, Benedick A., Pan, Charlie C., Lawrence, Theodore S., Ten Haken, Randall K., and Ben-Josef, Edgar. Thu . "Potential for dose-escalation and reduction of risk in pancreatic cancer using IMRT optimization with lexicographic ordering and gEUD-based cost functions". United States. doi:10.1118/1.2426403.
@article{osti_20951046,
title = {Potential for dose-escalation and reduction of risk in pancreatic cancer using IMRT optimization with lexicographic ordering and gEUD-based cost functions},
author = {Spalding, Aaron C. and Jee, Kyung-Wook and Vineberg, Karen and Jablonowski, Marla and Fraass, Benedick A. and Pan, Charlie C. and Lawrence, Theodore S. and Ten Haken, Randall K. and Ben-Josef, Edgar},
abstractNote = {Radiotherapy for pancreatic cancer is limited by the tolerance of local organs at risk (OARs) and frequent overlap of the planning target volume (PTV) and OAR volumes. Using lexicographic ordering (LO), a hierarchical optimization technique, with generalized equivalent uniform dose (gEUD) cost functions, we studied the potential of intensity modulated radiation therapy (IMRT) to increase the dose to pancreatic tumors and to areas of vascular involvement that preclude surgical resection [surgical boost volume (SBV)]. We compared 15 forward planned three-dimensional conformal (3DCRT) and IMRT treatment plans for locally advanced unresectable pancreatic cancer. We created IMRT plans optimized using LO with gEUD-based cost functions that account for the contribution of each part of the resulting inhomogeneous dose distribution. LO-IMRT plans allowed substantial PTV dose escalation compared with 3DCRT; median increase from 52 Gy to 66 Gy (a=-5,p<0.005) and median increase from 50 Gy to 59 Gy (a=-15,p<0.005). LO-IMRT also allowed increases to 85 Gy in the SBV, regardless of a value, along with significant dose reductions in OARs. We conclude that LO-IMRT with gEUD cost functions could allow dose escalation in pancreas tumors with concomitant reduction in doses to organs at risk as compared with traditional 3DCRT.},
doi = {10.1118/1.2426403},
journal = {Medical Physics},
number = 2,
volume = 34,
place = {United States},
year = {Thu Feb 15 00:00:00 EST 2007},
month = {Thu Feb 15 00:00:00 EST 2007}
}