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Title: SU-F-T-422: Detection of Optimal Tangential Partial Arc Span for VMAT Planning in IntactLeft-Breast Treatment

Abstract

Purpose: This study was designed to investigate an appropriate arc span for intact partial Left breast irradiation by VMAT planning. Methods: Four cases of carcinoma left intact breast was chosen randomly for this study. Both medial tangential and left-lateral tangential arc (G20°, G25°, G30°, G35°, G40°) were used having the same length and bilaterally symmetric. For each patient base plan was generated for 30° arc and rest of other arc plans were generated by keeping all plan parameters same, only arc span were changed. All patient plans were generated on treatment planning system Monaco (V 5.00.02) for 50 Gy dose in 25 fractions. PTV contours were clipped 3 mm from skin (patient). All plans were normalized in such a way that 95 % of prescription dose would cover 96 % of PTV volume. Results: Mean MU for 20°, 25°, 30°, 35° and 40° were 509 ± 18.8, 529.1 ± 20.2, 544.4 ± 20.8, 579.1 ±51.8, 607.2 ± 40.2 similarly mean hot spot (volume covered by 105% of prescription dose) were 2.9 ± 1.2, 3.7 ± 3.0, 1.5 ± 1.7, 1.3±0.6, 0.4 ± 0.4, mean contralateral breast dose (cGy) were 180.4 ± 242.3, 71.5 ± 52.7, 76.2 ± 58.8, 85.9 ±more » 70.5, 90.7 ± 70.1, mean heart dose (cGy) were 285.8 ± 87.2, 221.2 ± 62.8, 274.5 ± 95.5, 234.8 ± 73.8, 263.2 ± 81.6, V20 for ipsilateral lung were 15.4 ± 5.3, 14.3 ± 3.6, 15.3 ± 2.9, 14.2 ± 3.9, 14.7 ± 3.2 and V5 for ipsilateral lung were 33.9 ± 8.2, 31.0 ± 3.5, 42.6 ±15.6, 36.4 ± 12.9, 37.0 ± 7.5. Conclusion: The study concluded that appropriate arc span used for tangential intact breast treatment was optimally 30° because larger arc span were giving lower isodose spill in ipsilateral lung and smaller arc were giving heterogeneous dose distribution in PTV.« less

Authors:
; ; ; ; ; ; ; ;  [1]
  1. Fortis Memorial Research Institute, Gurgaon, Haryana (India)
Publication Date:
OSTI Identifier:
22649015
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; HOT SPOTS; LUNGS; MAMMARY GLANDS; PATIENTS; PLANNING; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY

Citation Formats

Giri, U, Sarkar, B, Munshi, A, Kaur, H, Jassal, K, Rathinamuthu, S, Kumar, S, Ganesh, T, and Mohanti, B. SU-F-T-422: Detection of Optimal Tangential Partial Arc Span for VMAT Planning in IntactLeft-Breast Treatment. United States: N. p., 2016. Web. doi:10.1118/1.4956607.
Giri, U, Sarkar, B, Munshi, A, Kaur, H, Jassal, K, Rathinamuthu, S, Kumar, S, Ganesh, T, & Mohanti, B. SU-F-T-422: Detection of Optimal Tangential Partial Arc Span for VMAT Planning in IntactLeft-Breast Treatment. United States. doi:10.1118/1.4956607.
Giri, U, Sarkar, B, Munshi, A, Kaur, H, Jassal, K, Rathinamuthu, S, Kumar, S, Ganesh, T, and Mohanti, B. 2016. "SU-F-T-422: Detection of Optimal Tangential Partial Arc Span for VMAT Planning in IntactLeft-Breast Treatment". United States. doi:10.1118/1.4956607.
@article{osti_22649015,
title = {SU-F-T-422: Detection of Optimal Tangential Partial Arc Span for VMAT Planning in IntactLeft-Breast Treatment},
author = {Giri, U and Sarkar, B and Munshi, A and Kaur, H and Jassal, K and Rathinamuthu, S and Kumar, S and Ganesh, T and Mohanti, B},
abstractNote = {Purpose: This study was designed to investigate an appropriate arc span for intact partial Left breast irradiation by VMAT planning. Methods: Four cases of carcinoma left intact breast was chosen randomly for this study. Both medial tangential and left-lateral tangential arc (G20°, G25°, G30°, G35°, G40°) were used having the same length and bilaterally symmetric. For each patient base plan was generated for 30° arc and rest of other arc plans were generated by keeping all plan parameters same, only arc span were changed. All patient plans were generated on treatment planning system Monaco (V 5.00.02) for 50 Gy dose in 25 fractions. PTV contours were clipped 3 mm from skin (patient). All plans were normalized in such a way that 95 % of prescription dose would cover 96 % of PTV volume. Results: Mean MU for 20°, 25°, 30°, 35° and 40° were 509 ± 18.8, 529.1 ± 20.2, 544.4 ± 20.8, 579.1 ±51.8, 607.2 ± 40.2 similarly mean hot spot (volume covered by 105% of prescription dose) were 2.9 ± 1.2, 3.7 ± 3.0, 1.5 ± 1.7, 1.3±0.6, 0.4 ± 0.4, mean contralateral breast dose (cGy) were 180.4 ± 242.3, 71.5 ± 52.7, 76.2 ± 58.8, 85.9 ± 70.5, 90.7 ± 70.1, mean heart dose (cGy) were 285.8 ± 87.2, 221.2 ± 62.8, 274.5 ± 95.5, 234.8 ± 73.8, 263.2 ± 81.6, V20 for ipsilateral lung were 15.4 ± 5.3, 14.3 ± 3.6, 15.3 ± 2.9, 14.2 ± 3.9, 14.7 ± 3.2 and V5 for ipsilateral lung were 33.9 ± 8.2, 31.0 ± 3.5, 42.6 ±15.6, 36.4 ± 12.9, 37.0 ± 7.5. Conclusion: The study concluded that appropriate arc span used for tangential intact breast treatment was optimally 30° because larger arc span were giving lower isodose spill in ipsilateral lung and smaller arc were giving heterogeneous dose distribution in PTV.},
doi = {10.1118/1.4956607},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To choose appropriate gantry starting angle for partial left breast irradiation using volumetric modulated arc therapy (VMAT). Methods: A random patient of left breast carcinoma was selected for this study. The slice which was selected for this mathematical formulation was having maximum breast thickness and maximum medial and lateral tangential distance. After this appropriate isocenter was chosen on that CT slice. The distances between various points were measured by the measuring tool in Monaco 5.00.04. Using the various trigonometric equations, a final equation was derived which shows the relationship between Gantry start angle, isocenter Location and tissue thickness. Results:more » The final equation for gantry start for right medial tangential arc is given asStarting angle = 270°+tan^(−1)(sin(θ)/(x-1/x-2 +cosθ))The above equation was tested for 10 cases and it was found to be appropriate for all the cases. Conclusion: Gantry starting angle for partial arc irradiation depends upon Breast thickness, Distance between Medial and lateral tangent and isocenter location.« less
  • The use of transverse tomography treatment-planning scans, which have to be taken in the exact treatment position of the patients, is essential for precision radiotherapy of breast cancer. Transverse tomography scans give all necessary informations for an optimal isodose distribution within the target volume for the individual patient, and maximal sparing of normal tissues (e.g. lung) is achieved. The exact topography of internal mammary nodes may also be incorporated in the planning scan with the help of lymphoscintigraphy. Conventional computerized tomography (CT) scanners have too small gantry openings (50-70 cm) to allow for proper positioning of the patients under treatmentmore » conditions. Using such treatment-planning scans for patients in the actual treatment position would cause an underdosage in excess of 5% within the target volume, when /sup 60/Co fields are used. Also, a much larger volume of normal tissues (mainly lung) would unnecessarily be irradiated. Treatment-planning scans obtained by TAT (transverse analog tomography) do not have the crucial positioning problems of conventional CT scanners and enable the precise transformation of a valid isodose distribution to each patient. In addition, positioning wedges (with adjustable wedge angles) may be placed under the patient to achieve the optimal treatment position. A useful alternative of TAT scanning for precise treatment planning of patients with breast cancer would be a CT scanner with a wide enough gantry opening to allow for any patient positioning under actual treatment conditions.« less
  • Purpose: The purpose of this study is to determine the optimal treatment planning strategy among the different arc arrangements for prostate stereotactic body radiotherapy (SBRT) plans with volumetric modulated arc therapy (VMAT). Methods: Ten patients with prostate cancer were selected. The SBRT-VMAT plans for each patient were generated with single-full (181° to 179°; 1FA), single-partial (240° to 120°; 1PA), double-full (181° to 179° and 179° to 181°; 2FA), and double-partial (240° to 120° and 120° to 240°; 2PA) arc arrangements. The prescription dose was 42.7 Gy in 7 fractions. Dose distribution was calculated using a 10-MV flattening-filter-free beam and themore » Acuros XB algorithm. Dosimetric parameters of target volume and organs at risk (OARs) were evaluated from cumulative dose-volume histograms on prostate SBRT-VMAT plans between single-arc (1FA and 1PA) and double-arc (2FA and 2PA) arrangements. Results: All plans using four arc arrangements were highly conformal with conformity index (CI)<1.05 and conformation number (CN)=0.91, and the doses to target volume were homogeneous (homogeneity index (HI)= 0.09 0.12). Pertaining to the dose to the OARs, there were significant differences in the rectum, left and right femoral head doses while having no difference in the bladder dose. The partial-arc (1PA and 2PA) had relatively high reductions for the mean rectum dose compared to full-arc (1FA and 2FA). The near-to-maximum dose (D2%) and mean dose of the left and right femoral head were always lower on prostate SBRT-VMAT plan using the full-arc, when compared to the partial-arc arrangement. Conclusion: This study confirmed that prostate SBRT-VMAT using 1PA was feasible fast delivery time and produced equivalent target coverage and better rectum sparing, although the D2% and mean dose of the left and right femoral head increased slightly. Therefore, the results of this study suggest that the use of 1PA is an attractive choice for delivering prostate SBRT-VMAT.« less
  • Purpose: The RTOG 1005 trial offered a hypofractionated arm in delivering WBRT+SIB. Traditionally, treatments were planned at our institution using field-in-field (FiF) tangents with a concurrent 3D conformal boost. With the availability of VMAT, it is possible that a hybrid VMAT-3D planning technique could provide another avenue in treating WBRT+SIB. Methods: A retrospective study of nine patients previously treated using RTOG 1005 guidelines was performed to compare FiF+3D plans with the hybrid technique. A combination of static tangents and partial VMAT arcs were used in base-dose optimization. The hybrid plans were optimized to deliver 4005cGy to the breast PTVeval andmore » 4800cGy to the lumpectomy PTVeval over 15 fractions. Plans were optimized to meet the planning goals dictated by RTOG 1005. Results: Hybrid plans yielded similar coverage of breast and lumpectomy PTVs (average D95 of 4013cGy compared to 3990cGy for conventional), while reducing the volume of high dose within the breast; the average D30 and D50 for the hybrid technique were 4517cGy and 4288cGy, compared to 4704cGy and 4377cGy for conventional planning. Hybrid plans increased conformity as well, yielding CI95% values of 1.22 and 1.54 for breast and lumpectomy PTVeval volumes; in contrast, conventional plans averaged 1.49 and 2.27, respectively. The nearby organs at risk (OARs) received more low dose with the hybrid plans due to low dose spray from the partial arcs, but all hybrid plans did meet the acceptable constraints, at a minimum, from the protocol. Treatment planning time was also reduced, as plans were inversely optimized (VMAT) rather than forward optimized. Conclusion: Hybrid-VMAT could be a solution in delivering WB+SIB, as plans yield very conformal treatment plans and maintain clinical standards in OAR sparing. For treating breast cancer patients with a simultaneously-integrated boost, Hybrid-VMAT offers superiority in dosimetric conformity and planning time as compared to FIF techniques.« less
  • Purpose: To compare dose distribution and normal tissue sparing in partial-breast treatment using three-dimensional conformal radiotherapy (3D-CRT) vs. intensity-modulated radiotherapy (IMRT). Methods and Materials: Sixty-three patients with Tis-1N0M0 breast cancer were treated on a Phase II prospective accelerated partial-breast IMRT protocol at two facilities between April 2004 and January 2006. Fifty-six patients had data sets sufficient to adequately contour all structures. These cases were subsequently replanned with 3D-CRT techniques using the same contours, to compare the dose distribution patterns of 3D-CRT vs. IMRT. Results: The average planning target volume (PTV) to ipsilateral breast (IB) ratio was 24% (range, 7-58%). Themore » average volume of IB receiving 25%, 50%, 75%, and 100% of the prescribed dose was 4.0%, 5.0%, 5.5%, and 10.5% less with IMRT than with 3D (p < 0.01). The dose reduction to normal breast was further improved in the subset of patients whose PTV to IB ratio was >25%, and in patients with contoured breast volume <750 cm{sup 3}. No difference was detected in delivery to the lumpectomy cavity or clinical target volume. The PTV volume receiving 95% of the dose was higher in the 3D conformal plans (p < 0.01), but no significant difference was observed in the PTV volume receiving 90% (p = 0.17). The irradiated heart and lung volumes were small with both techniques but also favored IMRT. Conclusions: In T1N0 patients treated with external beam partial-breast radiotherapy, IMRT improves normal tissue sparing in the ipsilateral breast compared with 3DRT, without compromising dose delivery to the lumpectomy cavity and clinical target volume.« less