دورية أكاديمية
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Radiosurgery treatment planning using conformal arc informed volumetric modulated arc therapy.

التفاصيل البيبلوغرافية
العنوان: Radiosurgery treatment planning using conformal arc informed volumetric modulated arc therapy.
المؤلفون: Giles WM; Duke University Medical Center, Durham, NC, USA. Electronic address: william.giles@duke.edu., Cullom ET; Duke University, Durham, NC, USA., Laryea OA; Duke Kunshan University, Kunshan, Jiangsu, China., Nobah A; King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia., Alves VGL; University of Virginia Health System, Charlottesville, VA, USA., Yin FF; Duke University, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA., Kirkpatrick JP; Duke University, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA., Adamson JD; Duke University, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA.
المصدر: Medical dosimetry : official journal of the American Association of Medical Dosimetrists [Med Dosim] 2021 Spring; Vol. 46 (1), pp. 3-12. Date of Electronic Publication: 2020 Aug 15.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Science Country of Publication: United States NLM ID: 8908862 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4022 (Electronic) Linking ISSN: 18734022 NLM ISO Abbreviation: Med Dosim Subsets: MEDLINE
أسماء مطبوعة: Publication: <2000->: New York, NY : Elsevier Science
Original Publication: [Southwest Harbor, Me. : Beech Hill Pub.,
مواضيع طبية MeSH: Brain Neoplasms* , Radiosurgery* , Radiotherapy, Intensity-Modulated*, Humans ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted
مستخلص: Linac based radiosurgery to multiple metastases is commonly planned with volumetric modulated arc therapy (VMAT) as it effectively achieves high conformality to complex target arrangements. However, as the number of targets increases, VMAT can struggle to block between targets, which can lead to highly modulated and/or nonconformal multi-leaf collimator (MLC) trajectories that unnecessarily irradiation of healthy tissue. In this study we introduce, describe, and evaluate a treatment planning technique called Conformal Arc Informed VMAT (CAVMAT), which aims to reduce the dose to healthy tissue while generating highly conformal treatment plans. CAVMAT is a hybrid technique which combines the conformal MLC trajectories of dynamic conformal arcs with the MLC modulation and versatility of inverse optimization. CAVMAT has 3 main steps. First, targets are assigned to subgroups to maximize MLC blocking between targets. Second, arc weights are optimized to achieve the desired target dose, while minimizing MU variation between arcs. Third, the optimized conformal arc plan serves as the starting point for limited inverse optimization to improve dose conformity to each target. Twenty multifocal VMAT cases were replanned with CAVMAT with 20Gy applied to each target. The total volume receiving 2.5 Gy [cm 3 ], 6 Gy [cm 3 ], 12 Gy [cm 3 ], and 16 Gy [cm 3 ], conformity index, treatment delivery time, and the total MU were used to compare the VMAT and CAVMAT plans. In addition, CAVMAT was compared to a broad range of planning strategies from various institutions (108 linear accelerator based plans, 14 plans using other modalities) for a 5-target case utilized in a recent plan challenge. For the linear accelerator-based plans, a plan complexity metric based on aperture opening area and perimeter, total monitor units (MU), and MU for a given aperture opening was utilized in the plan challenge scoring algorithm to compare the submitted plans to CAVMAT. After re-planning the 20 VMAT cases, CAVMAT reduced the average V 2.5Gy [cm 3 ] by 25.25 ± 19.23%, V 6Gy [cm 3 ] by 13.68 ± 18.97%, V 12Gy [cm 3 ] by 11.40 ± 19.44%, and V 16Gy [cm 3 ] by 6.38 ± 19.11%. CAVMAT improved conformity by 3.81 ± 7.57%, while maintaining comparable target dose. MU for the CAVMAT plans increased by 24.35 ± 24.66%, leading to an increased treatment time of 2 minutes. For the plan challenge case, CAVMAT was 1 of 12 linac based plans that met all plan challenge scoring criteria. Compared to the average submitted VMAT plan, CAVMAT increased the V 10% Gy[%] of healthy tissue (Brain-PTV) by roughly 3.42%, but in doing so was able to reduce the V 25% Gy[%] by roughly 3.73%, while also reducing V 50% Gy[%] , V 75% Gy[%], and V 100% Gy[%] . The CAVMAT technique successfully eliminated insufficient MLC blocking between targets prior to the inverse optimization, leading to less complex treatment plans and improved tissue sparing. Tissue sparing, improved conformity, and decreased plan complexity at the cost of slight increase in treatment delivery time indicates CAVMAT to be a promising method to treat brain metastases.
(Copyright © 2020 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Keywords: DCA; SRS; Single-isocenter; VMAT
تواريخ الأحداث: Date Created: 20200819 Date Completed: 20211124 Latest Revision: 20211124
رمز التحديث: 20231215
DOI: 10.1016/j.meddos.2020.06.001
PMID: 32807612
قاعدة البيانات: MEDLINE
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