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1. Pediatric craniospinal irradiation with a short partial-arc VMAT technique for medulloblastoma tumors in dosimetric comparison

Author

Gerhard Pollul, Tilman Bostel, Sascha Grossmann, Sati Akbaba, Heiko Karle, Marcus Stockinger, and Heinz Schmidberger

Subjects
Pediatric radiation, Medulloblastoma, Craniospinal irradiation, Partial VMAT, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background This study aimed to contrast four different irradiation methods for pediatric medulloblastoma tumors in a dosimetric comparison regarding planning target volume (PTV) coverage and sparing of organs at risk (OARs). Methods In sum 24 treatment plans for 6 pediatric patients were realized. Besides the clinical standard of a 3D-conformal radiotherapy (3D-CRT) treatment plan taken as a reference, volumetric modulated arc therapy (VMAT) treatment plans (“VMAT_AVD” vs. “noAVD” vs. “FullArc”) were optimized and calculated for each patient. For the thoracic and abdominal region, the short partial-arc VMAT_AVD technique uses an arc setup with reduced arc-length by 100°, using posterior and lateral beam entries. The noAVD uses a half 180° (posterior to lateral directions) and the FullArc uses a full 360° arc setup arrangement. The prescription dose was set to 35.2 Gy. Results We identified a more conformal dose coverage for PTVs and a better sparing of OARs with used VMAT methods. For VMAT_AVD mean dose reductions in organs at risk can be realized, from 16 to 6.6 Gy, from 27.1 to 8.7 Gy and from 8.0 to 1.9 Gy for the heart, the thyroid and the gonads respectively, compared to the 3D-CRT treatment method. In addition we have found out a superiority of VMAT_AVD compared to the noAVD and FullArc trials with lower exposure to low-dose radiation to the lungs and breasts. Conclusions With the short partial-arc VMAT_AVD technique, dose exposures to radiosensitive OARS like the heart, the thyroid or the gonads can be reduced and therefore, maybe the occurrence of late sequelae is less likely. Furthermore the PTV conformity is increased. The advantages of the VMAT_AVD have to be weighed against the potentially risks induced by an increased low dose exposure compared to the 3D-CRT method.

Published
2020
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2. Planning Benchmark Study for Stereotactic Body Radiation Therapy of Liver Metastases: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery

Author

Christos Moustakis, Oliver Blanck, Mark ka heng Chan, Judit Boda-Heggemann, Nicolaus Andratschke, Marciana-Nona Duma, Dirk Albers, Christian Bäumer, Roman Fehr, Stefan A. Körber, Daniel Schmidhalter, Manfred Alraun, Wolfgang W. Baus, Eric Beckers, Mathias Dierl, Stephan Droege, Fatemeh Ebrahimi Tazehmahalleh, Jens Fleckenstein, Matthias Guckenberger, Christian Heinz, Christoph Henkenberens, Andreas Hennig, Janett Köhn, Christine Kornhuber, Thomas Krieger, Britta Loutfi-Krauss, Manfred Mayr, Markus Oechsner, Tina Pfeiler, Gerhard Pollul, Jürgen Schöffler, Heiko Tümmler, Claudia Ullm, Mathias Walke, Rocco Weigel, Martin Wertman, Rolf Wiehle, Tilo Wiezorek, Lotte Wilke, Ulrich Wolf, Hans Theodor Eich, and Daniela Schmitt

Subjects
Cancer Research, Benchmarking, Radiation, Oncology, Radiotherapy Planning, Computer-Assisted, Liver Neoplasms, Medizin, Humans, Radiology, Nuclear Medicine and imaging, Radiotherapy Dosage, Radiotherapy, Intensity-Modulated, Radiosurgery
Abstract

Our purpose was to investigate whether liver stereotactic body radiation therapy treatment planning can be harmonized across different treatment planning systems, delivery techniques, and institutions by using a specific prescription method and to minimize the knowledge gap concerning intersystem and interuser differences. We provide best practice guidelines for all used techniques.A multiparametric specification of target dose (gross target volume [GTV]GTVThis study showed the feasibility of harmonizing liver stereotactic body radiation therapy treatment plans across different treatment planning systems and delivery techniques when a sufficient set of clinical goals is given.

Published
2021

3. Planning benchmark study for SBRT of early stage NSCLC

Author

Juergen Schoeffler, Oliver Blanck, Matthias Guckenberger, Thomas Krieger, Matthias Kretschmer, Christine Kornhuber, R. Wiehle, Gerhard Pollul, Hans Theodor Eich, Ute Ganswindt, Iris Ernst, Cordula Petersen, Marciana-Nona Duma, Markus Oechsner, Ursula Nestle, Mark ka heng Chan, C. Heinz, Hilbert Blank, Heinrich Seegenschmiedt, C. Ostheimer, Eric Beckers, Uwe Haverkamp, Stefan Droege, Christos Moustakis, Wolfgang W. Baus, Fatemeh Ebrahimi Tazehmahalleh, H. Alheit, Katrin Jurianz, Georg Altenstein, Ulrich Wolf, Florian Sterzing, and Torsten Maass

Subjects
medicine.medical_specialty, Lung Neoplasms, medicine.medical_treatment, Planning target volume, Stereotactic radiation therapy, Radiosurgery, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, Stereotactic radiotherapy, 03 medical and health sciences, 0302 clinical medicine, Carcinoma, Non-Small-Cell Lung, Germany, Prevalence, medicine, Humans, Dosimetry, Radiology, Nuclear Medicine and imaging, Medical physics, Stage (cooking), Radiation treatment planning, Neoplasm Staging, business.industry, Radiotherapy Planning, Computer-Assisted, Reproducibility of Results, Radiotherapy Dosage, Radiation therapy, Benchmarking, Treatment Outcome, Oncology, 030220 oncology & carcinogenesis, Guideline Adherence, business, Quality assurance
Abstract

The aim was to evaluate stereotactic body radiation therapy (SBRT) treatment planning variability for early stage nonsmall cell lung cancer (NSCLC) with respect to the published guidelines of the Stereotactic Radiotherapy Working Group of the German Society for Radiation Oncology (DEGRO). Planning computed tomography (CT) scan and the structure sets (planning target volume, PTV; organs at risk, OARs) of 3 patients with early stage NSCLC were sent to 22 radiotherapy departments with SBRT experience: each department was asked to prepare a treatment plan according to the DEGRO guidelines. The prescription dose was 3 fractions of 15 Gy to the 65% isodose. In all, 87 plans were generated: 36 used intensity-modulated arc therapy (IMAT), 21 used three-dimensional conformal radiation therapy (3DCRT), 6 used static field intensity-modulated radiation therapy (SF-IMRT), 9 used helical radiotherapy and 15 used robotic radiosurgery. PTV dose coverage and simultaneously kept OARs doses were within the clinical limits published in the DEGRO guidelines. However, mean PTV dose (mean 58.0 Gy, range 52.8–66.4 Gy) and dose conformity indices (mean 0.75, range 0.60–1.00) varied between institutions and techniques (p ≤ 0.02). OARs doses varied substantially between institutions, but appeared to be technique independent (p = 0.21). All studied treatment techniques are well suited for SBRT of early stage NSCLC according to the DEGRO guidelines. Homogenization of SBRT practice in Germany is possible through the guidelines; however, detailed treatment plan characteristics varied between techniques and institutions and further homogenization is warranted in future studies and recommendations. Optimized treatment planning should always follow the ALARA (as low as reasonably achievable) principle.

Published
2017
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