Volumetric-modulated arc therapy vs c-IMRT in esophageal cancer:A treatment planning comparison

AIM:To compare the volumetric-modulated arc therapy AT plans ith conventional sliding indo intensity-modulated radiotherapy c-I RT plans in esophageal cancer EC . METHODS:Tenty patients ith EC ere selected, including 5 cases located in the cervical, the upper, the middle and the lo er thorax, respectively. Five plans ere generated ith the eclipse planning system:three using c-IMRT with 5 fields (5F), 7 fields (7F) and 9 fields (9F), and two using VMAT with a single arc 1A and double arcs 2A . The treatment plans ere designed to deliver a dose of 60 Gy to the plan-ning target volume Tith the same constrains in a 2.0 Gy daily fraction, 5 d a eek. lans ere normalized to 95% of the T that received 100% of the prescribed dose. We examined the dose-volume histogram parameters of T and the organs at risk OAR such as lungs, spinal cord and heart. onitor units U and normal tissue complication probability NTC of OAR ere also reported. RESULTS:Both c-I RT and AT plans resulted in abundant dose coverage of T for EC of different locations. The dose conformity to T as improved as the number of field in c-IMRT or rotating arc in VMAT as increased. The doses to T and OAR in AT plans ere not statistically different in comparison ith c-I RT plans, ith the follo ing exceptions:in cervical and upper thoracic EC, the conformity index CI as higher in VMAT (1A 0.78 and 2A 0.8) than in c-IMRT (5F 0.62, 7F 0.66 and 9F 0.73) and homogeneity was slightly better in c-IMRT (7F 1.09 and 9F 1.07) than in VMAT (1A 1.1 and 2A 1.09). Lung V30 was lower in VMAT (1A 12.52 and 2A 12.29) than in c-IMRT (7F 14.35 and 9F 14.81). The humeral head doses were significantly increased in AT as against c-I RT. In the middle and lower thoracic EC, CI in VMAT (1A 0.76 and 2A 0.74) was higher than in c-IMRT (5F 0.63 Gy and 7F 0.67 Gy), and homogeneity was almost similar bet een AT and c-I RT. 20 2A 21.49 Gy vs 7F 24.59 Gy and 9F 24.16 Gy) and V30 (2A 9.73 Gy vs 5F 12.61 Gy, 7F 11.5 Gy and 9F 11.37 Gy) of lungs in AT ere lo er than in c-I RT, but lo doses to lungs (V5 and V10) were increased. V30 (1A 48.12 Gy vs 5F 59.2 Gy, 7F 58.59 Gy and 9F 57.2 Gy), V40 and 50 of heart in AT as lo er than in c-I RT. Us in AT plans ere significantly reduced in comparison ith c-I RT, maximum doses to the spinal cord and mean doses of lungs ere similar bet een the t o techniques. NTC of spinal cord as 0 for all cases. NTC of lungs and heart in AT ere lo er than inc-I RT. The advantage of AT plan as enhanced by doubling the arc. CONCLUSION:Compared ith c-I RT, AT, especially the 2A, slightly improves the OAR dose sparing, such as lungs and heart, and reduces NTC and U ith a better T coverage.

DICOM-RT Plan Complexity Verification for Volumetric Modulated Arc Therapy

The purpose of this study was to investigate the relationship between plan parameters verified with DICOM-RT and dosimetric results for volumetric modulated arc therapy (VMAT). We investigated three treatment locations: prostate cancer (ten cases), maxillary sinus cancer (four cases), and malignant pleura mesothelioma (four cases) with treatment plans generated by a MonacoTM treatment planning system (TPS), and delivered with an Elekta SynergyTM linear accelerator. We calculated plan parameters, including gantry and multileaf collimator (MLC) positions, Monitor Units (MU), and millimeters of MLC motion per degree of gantry rotation (mm/degree), and performed quality assurance (QA) with a DICOM-RT plan verification system. We measured the VMAT dose with a two-dimensional diode array detector. The average gamma passing rate with percent dose acceptance criteria and distance to agreement criteria of 2 mm and 2% (2 mm/2%) were 97.4%, 97.8% and 92.0% for prostate cancer, maxillary sinus cancer, and malignant pleural mesothelioma, respectively. The mean 95th percentile value for DICOM-calculated mm/degree was 4.0, 5.2, and 11.1 for prostate cancer, maxillary sinus cancer, and malignant pleural mesothelioma, respectively. The gamma passing rate showed a correlation with calculated mm/degree, with a coefficient of determination (R2) of 0.60. Higher calculated mm/degree values led to increased dosimetric errors. We conclude that dose distribution calculated by a TPS is more reliable at smaller mm/degree.

Predicting Delivery Error Using a DICOM-RT Plan for Volumetric Modulated Arc Therapy

The purpose of this study was to investigate the prediction of mechanical error using DICOM-RT plan parameters for volumetric modulated arc therapy (VMAT). We created plans for gantry rotation arcs of 360° and 180° (full-arc and half-arc VMAT) for six maxillary sinus cancer cases using a Monaco treatment planning system, and delivered the doses with a linear accelerator. We calculated DICOM-RT plan parameters, including gantry, multileaf collimator (MLC) positions and Monitor Units (MU). We compared plans with regard to gantry angle per MU (degrees/MU) and MLC travel per MU (mm/MU) for each segment. Calculated gantry angle/MLC position speeds and errors were evaluated by comparison with the log file. On average, the half-arc VMAT plan resulted in 47% and 35% fewer degrees/MU and mm/MU than the full-arc VMAT plan, respectively. The root mean square (r.m.s.) gantry and MLC speeds showed a linear relationship with calculated degrees/MU and mm/MU, with coefficients of determination (R2) of 0.86 and 0.72, respectively. The r.m.s. gantry angle and MLC position errors showed a linear relationship with calculated degrees/MU and mm/MU with R2 of 0.63 and 0.76, respectively. Deviations from plan parameters were related to mechanical error for VMAT, and provided quantitative information without the need for VMAT delivery. These parameters can be used in the selection of treatment planning.

Evaluating the influence of 6 MV and 15 MV photon beams on prostate intensity-modulated radiation therapy plans

Objective We aimed to determine the effects of low- and high-energy intensity-modulated radiation therapy(IMRT) photon beams on the target volume planning and on the critical organs in the case of prostate cancer. Methods Thirty plans were generated by using either 6 MV or 15 MV beams separately, and a combination of both 6 and 15 MV beams. All plans were generated by using suitable planning objectives and dose constraints, which were identical across the plans, except the beam energy. The plans were analyzed in terms of their target coverage, conformity, and homogeneity, regardless of the beam energy. Results The mean percentage values of V_(70 Gy) for the rectal wall for the plans with 6 MV, 15 MV, and mixedenergy beams were 16.9%, 17.8%, and 16.4%, respectively, while the mean percentage values of V_(40 Gy) were 53.6%, 52.3%, and 50.4%. The mean dose values to the femoral heads for the 6 MV, 15 MV, and mixed-energy plans were 30.1 Gy, 25.5 Gy, and 25.4 Gy, respectively. The mean integral dose for the 6 MV plans was 10% larger than those for the 15 MV and mixed-energy plans. Conclusion These preliminary results suggest that mixed-energy IMRT plans may be advantageous with respect to the dosimetric characteristics of low- and high-energy beams. Although the reduction of dose to the organs at risk may not be clinically relevant, in this study, IMRT plans using mixed-energy beams exhibited better OAR sparing and overall higher plan quality for deep-seated tumors.

Auto-Planning在直肠癌容积旋转调强自动计划中的优化性能评估

目的:评估Pinnacle3 V9.10治疗计划系统的Auto-Planning(AP)模块在直肠癌容积旋转调强放射治疗(VMAT)自动计划中的优化性能。方法:采用随机数表法选取20例直肠癌患者,临床治疗计划均使用Pinnacle3 V9.10治疗计划系统的手动设计容积旋转调强(M-VMAT)计划,处方剂量为50 Gy/25 F。采集M-VMAT计划的剂量-体积直方图(DVH)参数作为计划优化参数进行自动优化VMAT(AP-VMAT)计划。将AP-VMAT计划与M-VMAT计划进行剂量学比较,评估AP模块优化性能。结果:AP-VMAT计划结果优于M-VMAT计划结果,靶区均匀指数和靶区适形指数具有统计学差异(t=0.036,t=0.006;P<0.05);膀胱平均剂量D(mean、肠V30、肠V15、肠平均剂量Dmean、左股骨头平均剂量Dmean和右股骨头结果存在统计学差异(t=0.048,t=0.012,t=0.002,t=0.001,t=0.045,t=0.004;P<0.05)。AP-VMAT计划剂量分布存在剂量外溢,略差于M-VMAT计划。结论:Auto-planning自动优化模块具有良好的自动优化性能,在精准的剂量预测条件下,可以通过使用剂量预测所得目标函数,实现直肠癌VMAT的精确自动优化。

Auto-planning技术用于胸中段食管癌调强放疗的可行性

目的探讨Auto-planning技术用于食管癌调强放疗计划设计的可行性。方法选取24例食管癌放疗病例,用Pinnacle 3计划系统设计自动治疗计划(ap-IMRT)和人工计划(m-IMRT),比较两种不同计划的剂量体积直方图(DVH),用配对t检验分析靶区和危及器官受照剂量的差异。结果肿瘤靶区GTV的D_(min)(t=-2.233,P=0.036)、均匀性指数HI(t=2.205,P=0.038),计划靶区PTV的D 98(t=-2.241,P=0.035)、HI(t=2.543,P=0.018)、适形度指数CI(t=-2.497,P=0.020),左肺V 20(t=4.412,P=0.000)、V_(30)(t=5.243,P=0.000),心脏V 30(t=2.546,P=0.018)、V_(40)(t=2.404,P=0.025)、D_(mean)(t=2.565,P=0.017),以上参数均是ap-IMRT计划优于m-IMRT。脊髓最大受照剂量D_(max)(t=-1.891,P=0.045),m-IMRT计划优于ap-IMRT。结论ap-IMRT靶区剂量分布能够达到较好均匀性和适形度,且能更地保护并行器官,但对串行器官脊髓的保护欠佳。

Leakage-Penumbra effect in intensity modulated radiation therapy step-and-shoot dose delivery

AIM: To study the leakage-penumbra(LP) effect with a proposed correction method for the step-and-shoot intensity modulated radiation therapy(IMRT).METHODS: Leakage-penumbra dose profiles from 10 randomly selected prostate IMRT plans were studied. The IMRT plans were delivered by a Varian 21 EX linear accelerator equipped with a 120-leaf multileaf collimator(MLC). For each treatment plan created by the Pinnacle3 treatment planning system,a 3-dimensional LP dose distribution generated by 5 coplanar photon beams,starting from 0o with equal separation of 72 o,was investigated. For each photon beam used in the stepand-shoot IMRT plans,the first beam segment was set to have the largest area in the MLC leaf-sequencing,and was equal to the planning target volume(PTV). The overshoot effect(OSE) and the segment positional errors were measured using a solid water phantom with Kodak(TL and X-OMAT V) radiographic films. Film dosimetric analysis and calibration were carried out using a film scanner(Vidar VXR-16). The LP dose profiles were determined by eliminating the OSE and segment positional errors with specific individual irradiations. RESULTS: A non-uniformly distributed leaf LP dose ranging from 3% to 5% of the beam dose was measured in clinical IMRT beams. An overdose at the gap between neighboring segments,represented as dose peaks of up to 10% of the total BP,was measured. The LP effect increased the dose to the PTV and surrounding critical tissues. In addition,the effectdepends on the number of beams and segments for each beam. Segment positional error was less than the maximum tolerance of 1 mm under a dose rate of 600 monitor units per minute in the treatment plans. The OSE varying with the dose rate was observed in all photon beams,and the effect increased from 1 to 1.3 Gy per treatment of the rectal intersection. As the dosimetric impacts from the LP effect and OSE may increase the rectal post-radiation effects,a correction of LP was proposed and demonstrated for the central beam profile for one of the planned beams. CONCLUSION: We concluded that the measured dosimetric impact of the LP dose inaccuracy from photon beam segment in step-and-shoot IMRT can be corrected.

基于Auto-planning技术的早期鼻咽癌容积旋转调强放射治疗计划评估

目的:比较基于Auto-planning技术的早期鼻咽癌容积旋转调强放射治疗(VMAT)计划和常规VMAT计划之间的剂量学差异以及计划质量。方法:回顾性分析20例早期鼻咽癌患者的临床资料,采用Pinnacle3计划系统的Auto-planning自动计划模块行VMAT自动计划设计,相应的常规VMAT计划由经验丰富的物理师完成设计,分别为aVMAT和mVMAT。对两组计划的肿瘤靶区剂量分布、危及器官剂量学、机器跳数和计划设计时间进行比较和评估。结果:两组计划靶区的剂量覆盖和适形度均满足处方要求。aVMAT组的PGTV、PTV2的剂量均匀性指数明显优于mVMAT组,但两者的适形度指数无显著差异性。此外,aVMAT计划比mVMAT计划可以更好地保护脊髓,而且在降低脑干的受照剂量亦具有优势。与mVMAT组相比,aVMAT组的平均机器跳数MU减少6.83%,平均计划设计时间减少14.50%。结论:对于早期鼻咽癌,基于Auto-planning技术所产生的自动VMAT计划,比常规VMAT计划具有更佳的靶区剂量分布,且更好地降低正常组织的剂量,同时具有更高的优化效率和计划执行效率。

Auto-planning在脑胶质瘤非共面容积调强放疗计划中的应用

目的:通过比较基于Auto-planning的胶质瘤非共面自动容积旋转调强放疗(AP-VMAT)计划与常规手动非共面VMAT(M-VMAT)计划在靶区和危及器官(OAR)的剂量学差异,探讨自动优化在非共面胶质瘤VMAT计划中应用的可行性。方法:选取2016-02-15~2016-12-18在广州医科大学附属肿瘤医院放疗科接受治疗的8例胶质瘤患者,进行CT模拟定位及靶区和OAR的勾画,采用Pinnacle 9.10治疗计划系统基于同一CT图像分别设计M-VMAT计划和AP-VMAT计划,比较手动和自动两种调强计划的靶区覆盖、分析靶区均匀性指数、适形度指数及OAR受照剂量差异。结果:两种计划靶区覆盖率、平均剂量(D_(mean))、均匀性指数差异均无统计学意义(P>0.05)。AP-VMAT计划的适形度指数明显优于M-VMAT计划,差异有统计学意义[(0.890±0.046)vs(0.750±0.046),P<0.001];两种计划OAR中脑干最大剂量、D_5,同侧眼球、晶体、视神经最大剂量、D_(mean)差异均无统计学意义(P>0.05),而AP-VMAT计划中脑干D_(mean)及视交叉、对侧眼球、晶体、视神经和正常脑组织的剂量评价参数均优于M-VMAT计划,差异有统计学意义(P<0.05)。结论:相比M-VMAT计划,基于Auto-planning的自动优化方式能够简化调强计划设计过程,并一定程度上改善靶区的剂量分布,降低OAR的受照剂量。

Feasibility of the partial-single arc technique in RapidArc planning for prostate cancer treatment

The volumetric modulated arc therapy(VMAT)technique,in the form of RapidArc,is widely used to treat prostate cancer.The full-single arc(f-SA)technique in RapidArc planning for prostate cancer treatment provides efficient treatment,but it also delivers a higher radiation dose to the rectum.This study aimed to compare the dosimetric results from the new partial-single arc(p-SA)technique with those from the f-SA technique in RapidArc planning for prostate cancer treatment.In this study,10 patients with lowrisk prostate cancer were selected.For each patient,two sets of RapidArc plans(f-SA and p-SA)were created in the Eclipse treatment planning system.The f-SA plan was created using one full arc,and the p-SA plan was created using planning parameters identical to those of the f-SA plan but with anterior and posterior avoidance sectors.Various dosimetric parameters of the f-SA and p-SA plans were evaluated and compared for the same target coverage and identical plan optimization parameters.The f-SA and p-SA plans showed an average difference of±1%for the doses to the planning target volume(PTV),and there were no clear differences in dose homogeneity or plan conformity.In comparison to the f-SA technique,the p-SA technique reduced the doses to the rectum by approximately 6.1%to 21.2%,to the bladder by approximately 10.3%to 29.5%,and to the penile bulb by approximately 2.2%.In contrast,the dose to the femoral heads,the integral dose,and the number of monitor units were higher in the p-SA plans by approximately 34.4%,7.7%,and 9.2%,respectively.In conclusion,it is feasible to use the p-SA technique for RapidArc planning for prostate cancer treatment.For the same PTV coverage and identical plan optimization parameters,the p-SA technique is better in sparing the rectum and bladder without compromising plan conformity or target homogeneity when compared to the f-SA technique.

基于Auto-Planning的食管癌容积旋转调强计划的剂量学比较

目的探讨自动计划模块(Auto-Planning)技术在食管癌容积旋转调强放疗(Volumetic Modulated Arc Therapy,VMAT)计划中的优势。方法选取13例Ⅱ~Ⅲ期同期放化疗的食管癌患者,在Pinnacle V9.10放疗计划系统中分别设计完成人工计划(Manual-VMAT)和基于Auto-Planning的自动计划(Auto-VMAT),比较两组计划靶区的剂量分布以及危及器官(Organ At Risk,OAR)受照剂量,并比较计划优化时间和机器总跳数。结果两种VMAT计划均能满足临床处方要求,Auto-VMAT计划在靶区剂量适形度、剂量均匀性方面均略优于Manual-VMAT计划,而且靶区平均剂量整体偏低。与Manual-VMAT计划比较,Auto-VMAT计划中双肺的D_(mean)、V_(20)、V_(30)分别平均降低3.1%、9.0%、19.1%,心脏的D_(mean)、V_(30)、V_(40)和脊髓D_(max)分别平均降低12.25%、23.0%、24.0%和3.6%左右,差异均有统计学意义(P<0.05)。Auto-VMAT和Manual-VMAT计划的平均优化时间分别为50 min和85 min;平均跳数分别为(422.3±60.7)和(381.8±66.7)MU,自动计划跳数增加了9.6%(P<0.05)。结论Auto-Planning技术应用于食管癌VMAT自动计划设计时可在保证靶区剂量覆盖的前提下降低OAR的受照剂量,有效缩短计划设计时间,提升计划设计效率。

Auto-planning在乳腺癌根治术后A-VMAT中的优化性能评估及临床应用

目的对基于Auto-planning(AP)技术的乳腺癌根治术后自动容积旋转调强放疗计划(Automated Volumetric Modulated Arc Therapy,A-VMAT)的优化性能与临床应用价值进行综合评估。方法选择24例乳腺癌根治术后患者,采用Pinnacle39.10计划系统手动设计容积旋转调强计划(Manual-VMAT,M-VMAT),采集其剂量体积直方图参数作为AP的优化参数以实现A-VMAT计划,分别比较两组计划靶区和危及器官的各项参数,评估AP技术的优化性能。结果左、右两侧乳腺癌A-VMAT计划的CI及HI结果均优于M-VMAT计划(t=5.53、-4.42;t=3.94、5.61;P<0.05)。健侧肺:A-VMAT计划V_(5)及以上的体积参数均低于M-VMAT计划,且仅V_(5)差异有统计学意义(t=3.64,2.32;P<0.05);而患侧肺仅V_(40)低于M-VMAT计划。心脏:左、右两侧乳腺癌A-VMAT计划的V_(2)高于M-VMAT计划;而右侧乳腺癌V_(5)以上的各参数则呈现相反趋势,仅V_(20)、V_(30)的差异有统计学意义(P<0.05)。A-VMAT计划的平均MUs值均小于M-VMAT计划,但无统计学差异。结论对于乳腺癌根治术后患者,与M-VMAT计划相比,A-VMAT计划具有更佳的靶区剂量分布及更低的正常组织受量。

Auto-Planning在肺癌调强放疗计划中的剂量学研究

目的比较基于Auto-Planning(AP)的肺癌调强放射治疗(Intensity-Modulated Radiation Therapy,IMRT)计划与物理师手动设计的IMRT计划的剂量学差异,研究AP在肺癌IMRT中的应用。方法选取16例肺癌病例,其中右肺癌7例,左肺癌7例,中央型肺癌2例,基于Pinnacle^3 V9.10计划系统分别进行AP计划设计和手动计划设计,比较两种不同计划的靶区剂量分布和危及器官受照剂量。结果与手动计划相比,AP计划提高了靶区的最小剂量D_(min),平均剂量D_(mean)更接近处方剂量,适形度更优。脊髓的最高剂量D_(max)和平均剂量D_(mean)均明显低于手动计划。双肺的平均剂量D_(mean)、V_(30)、V_(20)以及心脏的平均剂量D_(mean)和V_(40)也在一定程度上有所降低。差异均具有统计学意义。结论AP计划能够达到与手动计划一样满足临床要求的剂量分布,且AP计划能够提高靶区最低剂量和适形度,降低脊髓、肺等危及器官的受照剂量。

Complex Target Volume Delineation and Treatment Planning in Radiotherapy for Malignant Pleural Mesothelioma (MPM)

Introduction: Radiotherapy alone or combined with surgery and/or chemotherapy is being investigated in the treatment of malignant pleural mesothelioma (MPM). This study aimed to simulate a Volumetric Modulated Arc Therapy (VMAT) treatment of a patient with MPM. Materials and Methods: CT images from a patient with intact lungs were imported via DICOM into the Pinnacle3 treatment planning (TP) system (TPS) and used as a model for MPM to delineate organs at risk (OAR) and both clinical and planning target volumes (CTV and PTV) with a margin of 5 mm. Elekta Synergy with 6 MV photons and 80 leafs MLCi2 was employed. VMAT plans were generated using two coplanar arcs with gantry rotation angles of 178° - 182°, the collimator angles of each arc were set to 90°, Octavius® 4D 729 was employed for quality assurance while the calculated and measured doses were compared using VeriSoft. Results: A TP was achieved. The Gamma volume analysis with criteria of 3 mm distance to agreement and 3% dose difference yielded the gamma passing rate = 99.9%. The reference isodose was 42.75 Gy with the coverage constraints for the PTV D95 and V95 = 95.0% of 45 Gy. The remaining dosimetric parameters met the recommendations from the clinically acceptable guidelines for the radiotherapy of MPM. Conclusion: Using well-defined TV and VMAT, a consistent TP compared to similar ones from publications was achieved. We obtained a high agreement between the 3D dose reconstructed and the dose calculated.

Comparison of Dosiology between Three Dimensional Conformal and Intensity-modulated Radiotherapies (5 and 7 fields) in Gastric Cancer Post-surgery

The purpose of this study was to compare the dose distribution of intensity-modulated ra- diotherapy （IMRT） in 7 and 5 fields as well as 3-D conformal radiotherapy （3D-CRT） plans for gastric cancer using dosimetric analysis. In 15 patients with gastric cancer after D1 resection, dosimetric pa- rameters for IMRT （7 and 5 fields） and 3D-CRT were calculated with a total dose of 45 Gy （1.8 Gy/day） These parameters included the conformal index （CI）, homogeneity index （HI）, maximum dose spot for the planned target volume （PTV）, dose-volume histogram （DVH） and dose distribution in the organs at risk （OAR）, mean dose （Dmean）, maximal dose （Dmax） in the spinal cord, percentage of the normal liver volume receiving more than 30 Gy （V30） and percentage of the normal kidney volume receiving more than 20 Gy （V20）. IMRT （7 and 5 fields） and 3D-CRT achieved the PTV coverage. However, IMRT presented significantly higher CI and HI values and lower maximum dose spot distribution than 3D-CRT （P=0.001）. For dose distribution of OAR, IMRT had a significantly lower Dmean and Dmax in spinal cord than 3D-CRT （P=-0.009）. There was no obvious difference in V30 of liver and V20 of kidney between IMRT and 3D-CRT, but 5-field IMRT showed lower Dmean in the normal liver than other two plans （P=0.001）. IMRT revealed favorable tumor coverage as compared to 3D-CRT and IMRT plans. Specifically, 5-field IMRT plan was superior to 3D-CRT in protecting the spinal cord and liver, but this superiority was not observed in the kidney. Further studies are needed to compare differences among the three approaches.

Benefits and Limitations of Volumetric Modulated Arc Therapy in Treating Bilateral Breast Cancer with Regional Lymph Nodes

Purpose: The study was performed comparing dosimetric characteristics of volumetric modulated arc therapy (VMAT) and field-in-field (FiF) techniques on a patient with synchronous bilateral breast carcinoma. Methods: The patients with bilateral breast cancer treatment were included in this study. A total dose of 40.05 Gy in 15 fractions was prescribed to the Planning Target Volume (PTV) of the whole bilateral breast cancer with the supraclavicular and infraclavicular nodes, with a complementary boost of 10 Gy in 4 fractions to the surgical bed (PTVboost). For both radiotherapy techniques, several VxGy parameters were analyzed for the PTVs, together with the Conformity index (CI), the Homogeneity index (HI) and the critical organs at risk (OARs), lungs and heart. Results: The patient was treated by the VMAT technique and the daily treatment time was less than 20 minutes with daily CBCT imaging. In the VMAT plan, the PTV 95% dose covered 38.89 ± 0.81 Gy, compared to 37.26 ± 1.02 Gy in the FiF technique. The VMAT plan improved the dose homogeneity index and lower dose in lung towards high dose region. Conclusion: The study demonstrates the viability of the VMAT technique in the treatment of bilateral breast cancer. The introduced single isocentric VMAT technique is fast to deliver and it increases the dose homogeneity of the target volume with some limitations. The treatment was well tolerated, without interruption of the treatment courses caused by treatment-related toxicities.

基于Auto-Planning技术的肺癌容积旋转调强放疗计划评估

目的:比较基于Auto-Planning技术的自动肺癌容积旋转调强放射治疗(VMAT)计划与物理师手动设计的常规VMAT计划的剂量学差异,研究Auto-Planning技术在肺癌VMAT计划中的优化性能和临床应用价值。方法:随机选取25例已完成全程放疗的肺癌病例,应用Pinnacle3 V9.10计划系统分别进行基于Auto-Planning的自动计划(AP-VMAT)和常规手动计划(M-VMAT)设计,分析比较两组不同计划的肿瘤靶区剂量分布、危及器官受照剂量等剂量学参数。结果:两组计划的靶区覆盖度和危及器官限量均能满足临床要求。AP-VMAT计划靶区最大剂量略高于M-VMAT,但剂量适形度指数明显优于M-VMAT。与M-VMAT计划相比,AP-VMAT有效降低了脊髓受到的最大剂量和平均剂量,双肺的V_(30)、平均剂量以及心脏的V_(40)、V_(30)、平均剂量都在一定程度上有所降低,差异有统计学意义(P<0.05)。结论:对于肺癌VMAT放疗计划,AP-VMAT能够满足临床要求,且比M-VMAT具有更优的靶区适形度,同时可以有效降低脊髓、肺、心脏等危及器官的受照剂量,更好地保护正常组织。

Dosimetric consequences of tumor volume changes after kilovoltage cone-beam computed tomography for non-operative lung cancer during adaptive intensity-modulated radiotherapy or fractionated stereotactic radiotherapy

Objective The aim of this study was to investigate tumor volume changes with kilovoltage cone-beam computed tomography(k V-CBCT) and their dosimetric consequences for non-operative lung cancer during intensity-modulated radiotherapy(IMRT) or fractionated stereotactic radiotherapy.Methods Eighteen patients with non-operative lung cancer who received IMRT consisting of 1.8–2.2 Gy/fraction and five fractions per week or stereotactic radiotherapy with 5–8 Gy/fraction and three fractions a week were studied. k V-CBCT was performed once per week during IMRT and at every fraction during stereotactic radiotherapy. The gross tumor volume(GTV) was contoured on the k V-CBCT images,and adaptive treatment plans were created using merged k V-CBCT and primary planning computed tomography image sets. Tumor volume changes and dosimetric parameters,including the minimum dose to 95%(D95) or 1%(D1) of the planning target volume(PTV),mean lung dose(MLD),and volume of lung tissue that received more than 5(V5),10(V10),20(V20),and 30(V30) Gy were retrospectively analyzed.Results The average maximum change in GTV observed during IMRT or fractionated stereotactic radiotherapy was –25.85%(range,–13.09% ––56.76%). The D95 and D1 of PTV for the adaptive treatment plans in all patients were not significantly different from those for the initial or former adaptive treatment plans. In patients with tumor volume changes of >20% in the third or fourth week of treatment during IMRT,adaptive treatment plans offered clinically meaningful decreases in MLD and V5,V10,V20,and V30; however,in patients with tumor volume changes of < 20% in the third or fourth week of treatment as well as in patients with stereotactic radiotherapy,there were no significant or clinically meaningful decreases in the dosimetric parameters.Conclusion Adaptive treatment planning for decreasing tumor volume during IMRT may be beneficial for patients who experience tumor volume changes of >20% in the third or fourth week of treatment.

Evaluation of 3D-CRT and VMAT Radiotherapy Plans for Left Breast Cancer with Regional Lymph Nodes Irradiation

Introduction: Radiation therapy after breast surgery is an integral part of the treatment of early breast cancer. The goal of radiation therapy is to achieve the best possible coverage of the planning target volume (PTV), while reducing the dose to organs at risk (OARs) which are normal tissues whose sensitivity to irradiation could cause damage that can lead to modification of the treatment plan. In the last decade, radiation oncologist started to use the Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for irradiating the breast, in order to achieve better dose distribution and target dose to the PTV and OAR. The aim of this study is to compare 2 external radiotherapy techniques (VMAT vs 3D) for patients with node-positive left breast cancer. Patients and Methods: We randomly selected 10 cases of postoperative radiotherapy for breast cancer in our hospital. The patients are all female, the average age was 45.4 years old, and the primary lesions are left breast. The ANOVA test was used to compare the mean difference between subgroups, and the p value Results: Dose volume histogram (DVH) was used to analyze each evaluation dose of clinical target volume (CTV) and organs at risk (OARs). Compared to 3DCRT plans, VMAT provided more uniform coverage to the breast and regional lymph nodes. The max point dose for tVMAT was lower on average (106.4% for VMAT versus 109% for 3DCRT). OAR sparing was improved with tVMAT, with a lower average V17Gy for the left lung (27.91% for VMAT versus 30.04% for 3DCRT, p and lower for V28Gy (13.75% for VMAT versus 22.34% for 3DCRT, p = 0.01). We also found a lower V35Gy for the heart on VMAT plan (p = 0.02). On the contrary, dose of contralateral breast was lower in 3DCRT than VMAT (0.59 Gy vs 3.65 Gy, p = 0.00). Conclusion: The both types of plans can meet the clinical dosimetry demands of postoperative radiotherapy for left breast cancer. The VMAT plan has a better conformity, but 3CDRT can provide a lower dose to the contralateral organs (breast and lung) to avoid the risk of secondary cancers.