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Title: Dosimetric evaluation of parallel opposed spatially fractionated radiation therapy of deep-seated bulky tumors

Abstract

Application of a single fraction of parallel opposed GRID beams as a means of increasing the efficiency of radiation delivery to deep-seated tumors has been investigated. This evaluation was performed by measurement of dosimetric characteristics of the GRID radiation field in parallel opposed and single beam geometry. The limitations of the parallel opposed technique in terms of field size and tumor thickness have been evaluated for the conditions of acceptable spatial modulation. The results of this investigation have demonstrated an increase in therapeutic advantage for the parallel opposed technique over the single beam method when treating a deep seated tumor.

Authors:
; ; ; ; ;  [1]
  1. Department of Radiation Medicine, University of Kentucky Medical Center, Lexington, Kentucky 40536 (United States)
Publication Date:
OSTI Identifier:
20951052
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 34; Journal Issue: 2; Other Information: DOI: 10.1118/1.2431423; (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; BEAMS; DOSIMETRY; EVALUATION; MODULATION; NEOPLASMS; RADIOTHERAPY; THICKNESS

Citation Formats

Meigooni, Ali S., Gnaster, Michael, Dou, Kai, Johnson, Ellis L., Meigooni, Navid J., and Kudrimoti, Mahesh. Dosimetric evaluation of parallel opposed spatially fractionated radiation therapy of deep-seated bulky tumors. United States: N. p., 2007. Web. doi:10.1118/1.2431423.
Meigooni, Ali S., Gnaster, Michael, Dou, Kai, Johnson, Ellis L., Meigooni, Navid J., & Kudrimoti, Mahesh. Dosimetric evaluation of parallel opposed spatially fractionated radiation therapy of deep-seated bulky tumors. United States. doi:10.1118/1.2431423.
Meigooni, Ali S., Gnaster, Michael, Dou, Kai, Johnson, Ellis L., Meigooni, Navid J., and Kudrimoti, Mahesh. Thu . "Dosimetric evaluation of parallel opposed spatially fractionated radiation therapy of deep-seated bulky tumors". United States. doi:10.1118/1.2431423.
@article{osti_20951052,
title = {Dosimetric evaluation of parallel opposed spatially fractionated radiation therapy of deep-seated bulky tumors},
author = {Meigooni, Ali S. and Gnaster, Michael and Dou, Kai and Johnson, Ellis L. and Meigooni, Navid J. and Kudrimoti, Mahesh},
abstractNote = {Application of a single fraction of parallel opposed GRID beams as a means of increasing the efficiency of radiation delivery to deep-seated tumors has been investigated. This evaluation was performed by measurement of dosimetric characteristics of the GRID radiation field in parallel opposed and single beam geometry. The limitations of the parallel opposed technique in terms of field size and tumor thickness have been evaluated for the conditions of acceptable spatial modulation. The results of this investigation have demonstrated an increase in therapeutic advantage for the parallel opposed technique over the single beam method when treating a deep seated tumor.},
doi = {10.1118/1.2431423},
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}
}
  • The purpose of this study was to explore the treatment planning methods of spatially fractionated megavoltage grid therapy for treating bulky lung tumors using multileaf collimator (MLC). A total of 5 patients with lung cancer who had gross tumor volumes ranging from 277 to 635 cm{sup 3} were retrospectively chosen for this study. The tumors were from 6.5 to 9.6 cm at shortest dimension. Several techniques using either electronic compensation or intensity-modulated radiation therapy (IMRT) were used to create a variety of grid therapy plans on the Eclipse treatment planning system. The dose prescription point was calculated to the volume,more » and a dose of 20 Gy with 6-MV/15-MV beams was used in each plan. The dose-volume histogram (DVH) curves were obtained to evaluate dosimetric characteristics. In addition, DVH curves from a commercially available cerrobend grid collimator were also used for comparison. The linear-quadratic radiobiological response model was used to assess therapeutic ratios (TRs) and equivalent uniform doses (EUD) for all generated plans. A total of 6 different grid therapy plans were created for each patient. Overall, 4 plans had different electronic compensation techniques: Ecomps-Tubes, Ecomps-Circles, Ecomps-Squares, and Ecomps-Weave; the other 2 plans used IMRT and IMRT-Weave techniques. The DVH curves and TRs demonstrated that these MLC-based grid therapy plans can achieve dosimetric properties very similar to those of the cerrobend grid collimator. However, the MLC-based plans have larger EUDs than those with the cerrobend grid collimator. In addition, the field shaping can be performed for targets of any shape in MLC-based plans. Thus, they can deliver a more conformal dose to the targets and spare normal structures better than the cerrobend grid collimator can. The plans generated by the MLC technique demonstrated the advantage over the standard cerrobend grid collimator on accommodating targets and sparing normal structures. Overall, 6 different plans showed 6 different dosimetric parameters. However, an optimal grid therapy plan selection from among these 6 types requires more information from clinical trials and radiobiological studies.« less
  • Purpose: IMRT is preferred in the range of 6–10MV X-rays. Partially adding high energy (>10MV) treatment fields, may provide advantage of both higher and lower energies. To study IMRT dose distribution obtained from treatment plans with single (6MV) and mixed-energy (6MV and 15MV) for deep seated targets (separation more than 30cm). Methods: Five patients of carcinoma of cervix were studied using eclipse planning system. Two different dynamic IMRT plans were generated for Varian CL2300C/D linear accelerator; one is by using 6MV X-ray with seven equally spaced coplanar beams. In second plan, 2 lateral oblique fields (gantry angle 102°, 255°) beammore » energy was modified to 15MV by keeping all other parameters and dose volume constraints constant. Dose prescription for the planning target volume (PTV) was (5040cGy/28f). For plan comparison, dose volume histogram (DVH) was used and PTV coverage index (CI=Target volume covered by prescription dose/Target volume), heterogeneity index (D5/D95), mean dose to organ at risk (OAR) and normal tissue integral dose (NTID, liter-Gray) was also noted. Total monitor unit (MU) required to deliver a plan was also noted. Results: Mixed-energy plan showed a better conformity and CI values were 0.942±0.032 and 0.960±0.040 for single-energy and mixed-energy plan, respectively. In addition, HI value of mixed energy beam is comparable to that of single energy and the values were within 1.084±0.034 and 1.082±0.032 for single energy and mixed-energy plan, respectively. Variation in mean dose to bladder, rectum and bowel were within 1.05%, 0.87% and 0.90%. NTID was lesser for mixed-energy beam due to use of two high-energy fields. NTID were 1573.40±214.60 and 1510.20±249.80 litre-Gray for single energy and mixed-energy plan. MU needed to deliver a plan was similar in both plans and MUs were 238±45 and 237±47. Conclusion: Partial use of 15MV treatment fields in IMRT plan for deep seated targets showed dosimetric advantage over 6MV plan.« less
  • Early experience with stereotactic body radiation therapy (SBRT) of centrally located lung tumors indicated increased rate of high-grade toxicity in the lungs. These clinical results were based on treatment plans that were computed using pencil beam–like algorithms and without tissue inhomogeneity corrections. In this study, we evaluated the dosimetric errors in plans with and without inhomogeneity corrections and with planning target volumes (PTVs) that were within the zone of the proximal bronchial tree (BT). For 10 patients, the PTV, lungs, and sections of the BT either inside or within 2 cm of the PTV were delineated. Two treatment plans weremore » generated for each patient using the following dose-calculation methods: (1) pencil beam (PB) algorithm without inhomogeneity correction (IC) (PB − IC) and (2) PB with inhomogeneity correction (PB + IC). Both plans had identical beam geometry but different beam segment shapes and monitor units (MU) to achieve similar conformal dose coverage of PTV. To obtain the baseline dose distributions, each plan was recalculated using a Monte Carlo (MC) algorithm by keeping MUs the same in the respective plans. The median maximum dose to the proximal BT and PTV dose coverage in the PB + IC plans were overestimated by 8% and 11%, respectively. However, the median maximum dose to the proximal BT and PTV dose coverage in PB − IC plans were underestimated by 15% and 9%. Similar trends were observed in low-dose regions of the lung within the irradiated volume. Our study indicates that dosimetric bias introduced by unit tissue density plans cannot be characterized as underestimation or overestimation of dose without taking the tumor location into account. This issue should be considered when analyzing clinical toxicity data from early lung SBRT trials that utilized unit tissue density for dose calculations.« less
  • Purpose: To determine dosimetric impact of positioning errors in the stereotactic hypo-fractionated treatment of intracranial lesions using 3Dtransaltional and 3D-rotational corrections (6D) frameless BrainLAB ExacTrac X-Ray system. Methods: 20 cranial lesions, treated in 3 or 5 fractions, were selected. An infrared (IR) optical positioning system was employed for initial patient setup followed by stereoscopic kV X-ray radiographs for position verification. 6D-translational and rotational shifts were determined to correct patient position. If these shifts were above tolerance (0.7 mm translational and 1° rotational), corrections were applied and another set of X-rays was taken to verify patient position. Dosimetric impact (D95, Dmin,more » Dmax, and Dmean of planning target volume (PTV) compared to original plans) of positioning errors for initial IR setup (XC: Xray Correction) and post-correction (XV: X-ray Verification) was determined in a treatment planning system using a method proposed by Yue et al. (Med. Phys. 33, 21-31 (2006)) with 3D-translational errors only and 6D-translational and rotational errors. Results: Absolute mean translational errors (±standard deviation) for total 92 fractions (XC/XV) were 0.79±0.88/0.19±0.15 mm (lateral), 1.66±1.71/0.18 ±0.16 mm (longitudinal), 1.95±1.18/0.15±0.14 mm (vertical) and rotational errors were 0.61±0.47/0.17±0.15° (pitch), 0.55±0.49/0.16±0.24° (roll), and 0.68±0.73/0.16±0.15° (yaw). The average changes (loss of coverage) in D95, Dmin, Dmax, and Dmean were 4.5±7.3/0.1±0.2%, 17.8±22.5/1.1±2.5%, 0.4±1.4/0.1±0.3%, and 0.9±1.7/0.0±0.1% using 6Dshifts and 3.1±5.5/0.0±0.1%, 14.2±20.3/0.8±1.7%, 0.0±1.2/0.1±0.3%, and 0.7±1.4/0.0±0.1% using 3D-translational shifts only. The setup corrections (XC-XV) improved the PTV coverage by 4.4±7.3% (D95) and 16.7±23.5% (Dmin) using 6D adjustment. Strong correlations were observed between translation errors and deviations in dose coverage for XC. Conclusion: The initial BrainLAB IR system based on rigidity of the mask-frame setup is not sufficient for accurate stereotactic positioning; however, with X-ray imageguidance sub-millimeter accuracy is achieved with negligible deviations in dose coverage. The angular corrections (mean angle summation=1.84°) are important and cause considerable deviations in dose coverage.« less
  • Purpose: Spatially fractionated GRID radiotherapy (SFGRT) using a customized Cerrobend block has been used to improve response rates in patients with bulky tumors. The clinical efficacy of our own multileaf collimator (MLC) technique is unknown. We undertook a retrospective analysis to compare clinical response rates attained using these two techniques. Methods and Materials: Seventy-nine patients with bulky tumors (median diameter, 7.6 cm; range, 4-30 cm) treated with SFGRT were reviewed. Between 2003 and late 2005, the Cerrobend block technique (n = 39) was used. Between late 2005 and 2008, SFGRT was delivered using MLC-shaped fields (n = 40). Dose wasmore » prescribed to dmax (depth of maximum dose) and was typically 15 Gy. Eighty percent of patients in both groups received external beam radiotherapy in addition to SFGRT. The two-sided Fisher-Freeman-Halton test was used to compare pain and mass effect response rates between the two groups. Results: Sixty-one patients (77%) were treated for palliative intent and 18 (23%) for curative intent. The majority of patients had either lung or head-and-neck primaries in both groups; the most frequent site of SFGRT application was the neck. The majority of patients complained of either pain (65%) or mass effect (58%) at intake. Overall response rates for pain and mass response were no different between the Cerrobend and MLC groups: pain, 75% and 74%, respectively (p = 0.50), and mass effect, 67% and 73%, respectively (p = 0.85). The majority of toxicities were Grade 1 or 2, and only 3 patients had late Grade 3-4 toxicities. Conclusions: MLC-based and Cerrobend-based SFGRT have comparable and encouraging response rates when used either in the palliative or curative setting. MLC-based SGFRT should allow clinics to more easily adopt this novel treatment approach for the treatment of bulky tumors.« less