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Title: Postoperative Irradiation of Gynecologic Malignancies: Improving Treatment Delivery Using Aperture-Based Intensity-Modulated Radiotherapy

Abstract

Purpose: To evaluate dosimetric and treatment delivery advantages of aperture-based intensity-modulated radiotherapy (AB-IMRT) for the treatment of patients receiving whole pelvic radiotherapy for gynecologic malignancies. Methods and Materials: Nineteen patients undergoing pelvic radiotherapy after resection of endometrial cancers were selected. A 45-Gy dose was prescribed to the target volume delineated on a planning CT scan. An in-house inverse planning system, Ballista, was used to develop a treatment plan using aperture-based multileaf collimator segments. This approach was compared with conventional four-field, enlarged four-field, and static beamlet-based IMRT (BB-IMRT) techniques in terms of target coverage, dose-volume histogram statistics for surrounding normal tissues, and numbers of segments and monitor units (MU). Results: Three quarters (76.4%) of the planning target volume received the prescription dose with conventional four-field plans. With adequate target coverage, the Ballista plans significantly reduced the volume of bowel and bladder irradiated at the prescribed dose (p < 0.001), whereas the two approaches provided equivalent results for the rectum (p 0.5). On the other hand, AB-IMRT and BB-IMRT plans showed only small differences in dose-volume histogram statistics of unknown clinical impact, whereas Ballista plan delivery required on average 73% and 59% fewer segments and MU, respectively. Conclusion: With respect to conventionalmore » techniques, AB-IMRT for the treatment of gynecologic malignancies provides dosimetric advantages similar to those with BB-IMRT but with clear treatment delivery improvements.« less

Authors:
 [1];  [2];  [2];  [2];  [2];  [3];  [4];  [3];  [3];  [4]
  1. Departement de physique, de genie physique et d'optique, Universite Laval, Quebec, QC (Canada) and Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC (Canada). E-mail: sylvainn@rrsb.nb.ca
  2. Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC (Canada)
  3. Departement de physique, de genie physique et d'optique, Universite Laval, Quebec, QC (Canada)
  4. (Canada)
Publication Date:
OSTI Identifier:
20951683
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 68; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2007.01.046; PII: S0360-3016(07)00196-4; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; APERTURES; BLADDER; CARCINOMAS; COLLIMATORS; COMPUTERIZED TOMOGRAPHY; IRRADIATION; PATIENTS; RADIATION DOSES; RADIOTHERAPY; RECTUM

Citation Formats

Nadeau, Sylvain, Bouchard, Myriam, Germain, Isabelle, Raymond, Paul-Emile, Beaulieu, Frederic, Beaulieu, Luc, Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC, Roy, Rene, Gingras, Luc, and Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC. Postoperative Irradiation of Gynecologic Malignancies: Improving Treatment Delivery Using Aperture-Based Intensity-Modulated Radiotherapy. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2007.01.046.
Nadeau, Sylvain, Bouchard, Myriam, Germain, Isabelle, Raymond, Paul-Emile, Beaulieu, Frederic, Beaulieu, Luc, Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC, Roy, Rene, Gingras, Luc, & Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC. Postoperative Irradiation of Gynecologic Malignancies: Improving Treatment Delivery Using Aperture-Based Intensity-Modulated Radiotherapy. United States. doi:10.1016/j.ijrobp.2007.01.046.
Nadeau, Sylvain, Bouchard, Myriam, Germain, Isabelle, Raymond, Paul-Emile, Beaulieu, Frederic, Beaulieu, Luc, Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC, Roy, Rene, Gingras, Luc, and Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC. Fri . "Postoperative Irradiation of Gynecologic Malignancies: Improving Treatment Delivery Using Aperture-Based Intensity-Modulated Radiotherapy". United States. doi:10.1016/j.ijrobp.2007.01.046.
@article{osti_20951683,
title = {Postoperative Irradiation of Gynecologic Malignancies: Improving Treatment Delivery Using Aperture-Based Intensity-Modulated Radiotherapy},
author = {Nadeau, Sylvain and Bouchard, Myriam and Germain, Isabelle and Raymond, Paul-Emile and Beaulieu, Frederic and Beaulieu, Luc and Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC and Roy, Rene and Gingras, Luc and Departement de radio-oncologie et Centre de recherche de l'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Hotel-Dieu de Quebec, Quebec, QC},
abstractNote = {Purpose: To evaluate dosimetric and treatment delivery advantages of aperture-based intensity-modulated radiotherapy (AB-IMRT) for the treatment of patients receiving whole pelvic radiotherapy for gynecologic malignancies. Methods and Materials: Nineteen patients undergoing pelvic radiotherapy after resection of endometrial cancers were selected. A 45-Gy dose was prescribed to the target volume delineated on a planning CT scan. An in-house inverse planning system, Ballista, was used to develop a treatment plan using aperture-based multileaf collimator segments. This approach was compared with conventional four-field, enlarged four-field, and static beamlet-based IMRT (BB-IMRT) techniques in terms of target coverage, dose-volume histogram statistics for surrounding normal tissues, and numbers of segments and monitor units (MU). Results: Three quarters (76.4%) of the planning target volume received the prescription dose with conventional four-field plans. With adequate target coverage, the Ballista plans significantly reduced the volume of bowel and bladder irradiated at the prescribed dose (p < 0.001), whereas the two approaches provided equivalent results for the rectum (p 0.5). On the other hand, AB-IMRT and BB-IMRT plans showed only small differences in dose-volume histogram statistics of unknown clinical impact, whereas Ballista plan delivery required on average 73% and 59% fewer segments and MU, respectively. Conclusion: With respect to conventional techniques, AB-IMRT for the treatment of gynecologic malignancies provides dosimetric advantages similar to those with BB-IMRT but with clear treatment delivery improvements.},
doi = {10.1016/j.ijrobp.2007.01.046},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 68,
place = {United States},
year = {Fri Jun 01 00:00:00 EDT 2007},
month = {Fri Jun 01 00:00:00 EDT 2007}
}
  • Purpose: To assess disease control and acute and chronic toxicity with aperture-based intensity-modulated radiotherapy (AB-IMRT) for postoperative pelvic irradiation of endometrial cancer. Methods and Materials: Between January and July 2005, after hysterectomy for endometrial cancer, 15 patients received 45 Gy to the pelvis using AB-IMRT. The AB-IMRT plans were generated by an in-house treatment planning system (Ballista). The AB-IMRT plans were used for treatment and were dosimetrically compared with three other approaches: conventional four-field, enlarged four-field, and beamlet-based IMRT (BB-IMRT). Disease control and toxicity were prospectively recorded and compared with retrospective data from 30 patients treated with a conventional four-fieldmore » technique. Results: At a median follow-up of 27 months (range, 23-30), no relapse was noted among the AB-IMRT group compared with five relapses in the control group (p = 0.1). The characteristics of each group were similar, except for the mean body mass index, timing of brachytherapy, and applicator type used. Patients treated with AB-IMRT experienced more frequent Grade 2 or greater gastrointestinal acute toxicity (87% vs. 53%, p 0.02). No statistically significant difference was noted between the two groups regarding the incidence or severity of chronic toxicities. AB-IMRT plans significantly improved target coverage (93% vs. 76% of planning target volume receiving 45 Gy for AB-IMRT vs. conventional four-field technique, respectively). The sparing of organs at risk was similar to that of BB-IMRT. Conclusion: The results of our study have shown that AB-IMRT provides excellent disease control with equivalent late toxicity compared with the conventional four-field technique. AB-IMRT provided treatment delivery and quality assurance advantages compared with BB-IMRT and could reduce the risk of second malignancy compared with BB-IMRT.« less
  • Purpose: To perform a dosimetric comparison of intensity-modulated radiotherapy (IMRT), passive scattering proton therapy (PSPT), and intensity-modulated proton therapy (IMPT) to the para-aortic (PA) nodal region in women with locally advanced gynecologic malignancies. Methods and Materials: The CT treatment planning scans of 10 consecutive patients treated with IMRT to the pelvis and PA nodes were identified. The clinical target volume was defined by the primary tumor for patients with cervical cancer and by the vagina and paravaginal tissues for patients with endometrial cancer, in addition to the regional lymph nodes. The IMRT, PSPT, and IMPT plans were generated using themore » Eclipse Treatment Planning System and were analyzed for various dosimetric endpoints. Two groups of treatment plans including proton radiotherapy were created: IMRT to pelvic nodes with PSPT to PA nodes (PSPT/IMRT), and IMRT to pelvic nodes with IMPT to PA nodes (IMPT/IMRT). The IMRT and proton RT plans were optimized to deliver 50.4 Gy or Gy (relative biologic effectiveness [RBE)), respectively. Dose-volume histograms were analyzed for all of the organs at risk. The paired t test was used for all statistical comparison. Results: The small-bowel V{sub 20}, V{sub 30}, V{sub 35}, andV{sub 40} were reduced in PSPT/IMRT by 11%, 18%, 27%, and 43%, respectively (p < 0.01). Treatment with IMPT/IMRT demonstrated a 32% decrease in the small-bowel V{sub 20}. Treatment with PSPT/IMRT showed statistically significant reductions in the body V{sub 5-20}; IMPT/IMRT showed reductions in the body V{sub 5-15}. The dose received by half of both kidneys was reduced by PSPT/IMRT and by IMPT/IMRT. All plans maintained excellent coverage of the planning target volume. Conclusions: Compared with IMRT alone, PSPT/IMRT and IMPT/IMRT had a statistically significant decrease in dose to the small and large bowel and kidneys, while maintaining excellent planning target volume coverage. Further studies should be done to correlate the clinical significance of these findings.« less
  • Purpose: To investigate the dosimetric feasibility of linear accelerator-based intensity-modulated total marrow irradiation (IM-TMI) in patients with hematologic malignancies. Methods and Materials: Linear accelerator-based IM-TMI treatment planning was performed for 9 patients using the Eclipse treatment planning system. The planning target volume (PTV) consisted of all the bones in the body from the head to the mid-femur, except for the forearms and hands. Organs at risk (OAR) to be spared included the lungs, heart, liver, kidneys, brain, eyes, oral cavity, and bowel and were contoured by a physician on the axial computed tomography images. The three-isocenter technique previously developed bymore » our group was used for treatment planning. We developed and used a common dose-volume objective method to reduce the planning time and planner subjectivity in the treatment planning process. Results: A 95% PTV coverage with the 99% of the prescribed dose of 12 Gy was achieved for all nine patients. The average dose reduction in OAR ranged from 19% for the lungs to 68% for the lenses. The common dose-volume objective method decreased the planning time by an average of 35% and reduced the inter- and intra- planner subjectivity. Conclusion: The results from the present study suggest that the linear accelerator-based IM-TMI technique is clinically feasible. We have demonstrated that linear accelerator-based IM-TMI plans with good PTV coverage and improved OAR sparing can be obtained within a clinically reasonable time using the common dose-volume objective method proposed in the present study.« less
  • Purpose: To investigate the technical and dosimetric advantages and the efficacy of direct aperture optimized intensity-modulated radiation therapy (DAO-IMRT) over standard (e.g., beamlet optimized) IMRT and conventional three-dimensional conformal radiotherapy (3D-CRT) for whole breast irradiation in supine and prone positions. Methods and Materials: We retrospectively designed DAO-IMRT plans for 15 breast cancer patients in supine (10 patients) and prone (5 patients) positions with a goal of uniform dose coverage of the whole breast. These DAO-IMRT plans were compared with standard IMRT using beamlet optimization and conventional 3D-CRT plans using wedges. All plans used opposed tangential beam arrangements. Results: In allmore » cases, the DAO-IMRT plans were equal to or better than those generated with 3D-CRT and standard beamlet-IMRT. For supine cases, DAO-IMRT provided higher uniformity index (UI, defined as the ratio of the dose to 95% of breast volume to the maximum dose) than either 3D-CRT (0.88 vs. 0.82; p = 0.026) or beamlet-IMRT (0.89 vs. 0.85; p = 0.003). Direct aperture optimized IMRT also gave lower lung doses than either 3D-CRT (V20 = 7.9% vs. 8.6%; p = 0.024) or beamlet-IMRT (V20 = 8.4% vs. 9.7%; p = 0.0008) for supine patients. For prone patients, DAO-IMRT provided higher UI than either 3D-CRT (0.89 vs. 0.83; p = 0.027) or beamlet-IMRT (0.89 vs. 0.85; p = 0.003). The planning time for DAO-IMRT was approximately 75% less than that of 3D-CRT. The monitor units for DAO-IMRT were approximately 60% less than those of beamlet-IMRT. Conclusion: Direct aperture optimized IMRT improved the overall quality of dose distributions as well as the planning and delivery efficiency for treating whole breast in both supine and prone positions.« less
  • Purpose: To investigate the planning efficiency and dosimetric characteristics of hybrid direct aperture optimized (hDAO) intensity-modulated radiotherapy (IMRT) compared with forward planning (FP)-IMRT for whole breast irradiation with two tangential beams. Methods and Materials: A total of 15 patients with left-sided breast cancer, categorized with three different breast volumes, were selected for this study. All patients were treated with FP plans to 50 Gy in 25 fractions. The hDAO plans were created by combining two open fields with eight segments in two tangential beam directions and were inversely optimized. Results: The FP and hDAO plans achieved similar breast coverage andmore » sparing of critical organs. The volume of breast receiving 105% of the prescription dose was significantly smaller in the hDAO than in the FP plans: 25% vs. 63% (p = .008) for small, 22% vs. 57% (p = .005) for medium, and 28% vs. 53% (p = .005) for large breasts. Furthermore, the tumor cavity coverage was slightly better in the hDAO plans (92.4% vs. 90.9%). Conclusion: Compared with FP-IMRT, hDAO-IMRT provided dosimetric advantages, significantly reducing the size of the hot spot and slightly improving the coverage of the tumor cavity. In addition, hDAO-IMRT required less planning time and was less dependent on the planner's ability.« less