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Title: TH-E-BRF-11: Dynamic Treatment of Clinical Margins Beyond the PET-Avid Target in Emission Guided Radiation Therapy: A Retrospective Patient Study

Purpose: Emission guided radiation therapy (EGRT) is a new modality that uses PET emissions for direct real-time tumor tracking. Radiation beamlets are delivered along PET lines of response (LOR's) by a fast rotating PET-Linac closed ring gantry. In this work, we develop a scheme to treat clinical margins defined proximal to the moving PET-avid tumor, while maintaining EGRT's inherent real-time tracking ability. Methods: The principle of EGRT is to deliver radiation along PET emission paths to concentrate dose in the PET-avid gross tumor volume (GTV). To account for adjacent non- PET avid regions in the clinical volume (CTV) a method was developed that expands the set of radiation beamlet responses to include the effective margin extension from the GTV to the CTV. An LOR detection may now Result in multiple beamlet responses: one along the original LOR, and others that are adjacent to it in the direction of margin extension. Evaluation studies were performed on a 4D digital patient as well as a clinical breast cancer patient with moving lung tumors. Emission data were obtained using GATE and a commercial PET scanner. Dose delivery was simulated using VMC++. For the patient study, Philips Pinnacle was used for planning and Miradamore » RTx was used for deformable dose registration across multiple breathing phases. Results: Compared with IMRT, the EGRT margin extension method achieved a 25.3% and 9.0% relative increase in dose to 95% of the CTV for the digital and clinical patients, respectively. The corresponding CTV dose increases without margin extension were 9.7% and 1.4%. The organs at risk doses were kept similar or lower for EGRT in both cases, with tumor tracking preserved. Conclusions: With the capability of accurate treatment of the moving CTV, EGRT has the potential to enable a practical and effective implementation of 4D biologically guided radiation therapy. Authors SRM and AN are stockholders of RefleXion Medical.« less
Authors:
;  [1] ;  [2] ; ; ;  [3] ;  [4]
  1. RefleXion Medical, Burlingame, CA (United States)
  2. University of Florida, Gainesville, FL (United States)
  3. Stanford University, Stanford, CA (United States)
  4. UC Davis School of Medicine, Sacramento, CA (United States)
Publication Date:
OSTI Identifier:
22412412
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 41; Journal Issue: 6; Other Information: (c) 2014 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; LINEAR ACCELERATORS; LUNGS; MAMMARY GLANDS; NEOPLASMS; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; RADIATION DOSES; RADIOTHERAPY