Extended distance non-isocentric treatment in stereotactic body radiation therapy (SBRT) for lung cancer

Purpose: To obtain the maximum differential non-coplanar beams angle for a faster dose dropping outside Plan Target Volume (PTV) for lung cancer treated by Stereotactic body radiation therapy (SBRT), an extended distance non-isocentric (EDNI) treatment method was explored and developed.Methods: The EDNI requires delivering of the treatment beam at 120 cm or farther for sauce axial distance (SAD) instead of standard 100 cm. This change provides a more compact dose distribution around PTV and the lower toxicity to organs at risk (OAR) due to benefit of 120 cm SAD and more choice of beam and couch angle. A hand calculation formula for the translation between 100 SAD and EDNI was used to verify the treatment plan results. A phantom for end to end study based on this EDNI technique was used to compare with standard 100 SAD deliveries for SBRT. Three patients who underwent SBRT treatment were randomly chosen to demonstrate the benefits of EDNI technique. These treatment re-plans were applied to EDNI and evaluated for conformal index (CI) of PTV, R50% of PTV, 2 cm distance (D2cm) of PTV and Maximum dose (Dmax)of OARs to compare with original clinical plans.Results: All of the cases delivered by the EDNI technique satisfied dose requirements of RTOG 0263 and showed a faster dose dropping outside of PTV than standard SAD deliveries. The distance from PTV after 1.5 cm for the EDNI technique had a smaller maximum dose and much lower standard deviation for dose distribution. The EDNI applied plans for patients showed less R50% and D2cm of PTV (P≤ 0.05), also similar results for Dmax of esophagus, trachea and spinal cord.Conclusion: The EDNI method enhances the capabilities of linear accelerators as far as the increased gradient of dose drop-off outside of PTV is concerned. More angular separation between beams leads to more compact dose distributions, which allow decreasing volume of high dose exposure in SBRT treatments and better dose distribution on sensitive organs to minimize the treatment toxicity.</p

Extended distance non-isocentric treatment in stereotactic body radiation therapy (SBRT) for lung cancer

Purpose: To obtain the maximum differential non-coplanar beams angle for a faster dose dropping outside Plan Target Volume (PTV) for lung cancer treated by Stereotactic body radiation therapy (SBRT), an extended distance non-isocentric (EDNI) treatment method was explored and developed.Methods: The EDNI requires delivering of the treatment beam at 120 cm or farther for sauce axial distance (SAD) instead of standard 100 cm. This change provides a more compact dose distribution around PTV and the lower toxicity to organs at risk (OAR) due to benefit of 120 cm SAD and more choice of beam and couch angle. A hand calculation formula for the translation between 100 SAD and EDNI was used to verify the treatment plan results. A phantom for end to end study based on this EDNI technique was used to compare with standard 100 SAD deliveries for SBRT. Three patients who underwent SBRT treatment were randomly chosen to demonstrate the benefits of EDNI technique. These treatment re-plans were applied to EDNI and evaluated for conformal index (CI) of PTV, R50% of PTV, 2 cm distance (D2cm) of PTV and Maximum dose (Dmax)of OARs to compare with original clinical plans.Results: All of the cases delivered by the EDNI technique satisfied dose requirements of RTOG 0263 and showed a faster dose dropping outside of PTV than standard SAD deliveries. The distance from PTV after 1.5 cm for the EDNI technique had a smaller maximum dose and much lower standard deviation for dose distribution. The EDNI applied plans for patients showed less R50% and D2cm of PTV (P≤ 0.05), also similar results for Dmax of esophagus, trachea and spinal cord.Conclusion: The EDNI method enhances the capabilities of linear accelerators as far as the increased gradient of dose drop-off outside of PTV is concerned. More angular separation between beams leads to more compact dose distributions, which allow decreasing volume of high dose exposure in SBRT treatments and better dose distribution on sensitive organs to minimize the treatment toxicity

Dosimetric evaluation of heterogeneity corrections for RTOG 0236: stereotactic body radiotherapy of inoperable stage I-II non-small-cell lung cancer.

PURPOSE: Using a retrospective analysis of treatment plans submitted from multiple institutions accruing patients to the Radiation Therapy Oncology Group (RTOG) 0236 non-small-cell stereotactic body radiotherapy protocol, the present study determined the dose prescription and critical structure constraints for future stereotactic body radiotherapy lung protocols that mandate density-corrected dose calculations. METHOD AND MATERIALS: A subset of 20 patients from four institutions participating in the RTOG 0236 protocol and using superposition/convolution algorithms were compared. The RTOG 0236 protocol required a prescription dose of 60 Gy delivered in three fractions to cover 95% of the planning target volume. Additional requirements were specified for target dose heterogeneity and the dose to normal tissue/structures. The protocol required each site to plan the patient\u27s treatment using unit density, and another plan with the same monitor units and applying density corrections was also submitted. These plans were compared to determine the dose differences. Two-sided, paired Student\u27s t tests were used to evaluate these differences. RESULTS: With heterogeneity corrections applied, the planning target volume receiving \u3e/=60 Gy decreased, on average, 10.1% (standard error, 2.7%) from 95% (p = .001). The maximal dose to any point \u3e/=2 cm away from the planning target volume increased from 35.2 Gy (standard error, 1.7) to 38.5 Gy (standard error, 2.2). CONCLUSION: Statistically significant dose differences were found with the heterogeneity corrections. The information provided in the present study is being used to design future heterogeneity-corrected RTOG stereotactic body radiotherapy lung protocols to match the true dose delivered for RTOG 0236

Target tracking using DMLC for volumetric modulated arc therapy: A simulation study

Purpose: Target tracking using dynamic multileaf collimator (DMLC) is a promising approach for intrafraction motion management in radiation therapy. The purpose of this work is to develop a DMLC tracking algorithm capable of delivering volumetric-modulated arc therapy (VMAT) to the targets that experience two-dimensional (2D) rigid motion in the beam’s eye view