mARC vs. IMRT radiotherapy of the prostate with flat and flattening-filter-free beam energies

Radiation Oncology - Tập 9 - Trang 1-8 - 2014
Yvonne Dzierma1, Katharina Bell1, Jan Palm1, Frank Nuesken1, Norbert Licht1, Christian Rübe1
1Department of Radiotherapy, Saarland University Medical Center, Homburg, Germany

Tóm tắt

There as yet exists no systematic planning study investigating the novel mARC rotational radiotherapy technique, which is conceptually different from VMAT. We therefore present a planning study for prostate cancer, comparing mARC with IMRT treatment at the same linear accelerator equipped with flat and flattening-filter-free (FFF) photon energies. We retrospectively re-contoured and re-planned treatment plans for 10 consecutive prostate cancer patients. Plans were created for a Siemens Artiste linear accelerator with flat 6 MV and FFF 7 MV photons, using the Prowess Panther treatment planning system. mARC and IMRT plans were compared with each other considering indices for plan quality and dose to organs at risk. All plans were exported to the machine and irradiated while measuring scattered dose by thermoluminescent dosimeters placed on an anthropomorphic phantom. Treatment times were also measured and compared. All plans were found acceptable for treatment. There was no marked preference for either technique or energy from the point of view of target coverage and dose to organs at risk. Scattered dose was significantly decreased by the use of FFF energies. While mARC and IMRT plans were of very similar overall quality, treatment time could be markedly decreased both by the use of mARC and FFF energy. Highly conformal treatment plans could be created both by the use of flat 6 MV and FFF 7 MV energy, using IMRT or mARC. For all practical purposes, the FFF 7 MV energy and mARC plans are acceptable for treatment, a combination of both allowing a drastic reduction in treatment time from over 5 minutes to about half this value.

Tài liệu tham khảo

Kainz K, Chen GP, Chang YW, Prah D, Qi XS, Shukla HP, Stahl J, Li XA: A planning and delivery study of a rotational IMRT technique with burst delivery. Med Phys. 2011, 38: 5104-5118. 10.1118/1.3622612. Salter BJ, Sarkar V, Wang B, Shukla H, Szegedi M, Rassiah-Szegedi P: Rotational IMRT delivery using a digital linear accelerator in a very high dose rate ‘burst mode’. Phys Med Biol. 2011, 56: 1931-1946. 10.1088/0031-9155/56/7/002. Dzierma Y, Nuesken F, Licht N, Rübe C: A novel implementation of mARC treatment for non-dedicated planning systems using converted IMRT plans. Radiat Oncol. 2013, 8: 193-10.1186/1748-717X-8-193. Dzierma Y, Nuesken FG, Kremp S, Palm J, Licht NP, Rübe C: Commissioning and first clinical application of mARC treatment. Strahlenther Onkol. 2014, 190: 1046-1052. 10.1007/s00066-014-0662-9. Spahn U, Prott FJ: Erste Erfahrungen mit der modulierten Rotationsbestrahlung mARC am Linearbeschleuniger ARTISTE (First experiences with the modulated rotational mARC treatment at the Artiste linear accelerator). Strahlenther Onkol Suppl. 2013, 1: 62-63. Guckenberger M, Richter A, Krieger T, Wilbert J, Baier K, Flentje M: Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes?. Radiother Oncol. 2009, 93 (2): 259-265. 10.1016/j.radonc.2009.08.015. Michalski J, Purdy J, Watkins-Bruner D: RTOG P-0126: A Phase III Randomized Study of High-Dose 3D-CRT/IMRT Versus Standard Dose 3D-CRT/IMRT in Patients Treated for Localized Prostate Cancer. Available online at: http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0126. Gay HA, Barthold HJ, O’Meara E, Bosch WR, El Naga I, Al-Lozi R, Rosenthal SA, Lawton C, Lee WR, Sandler H, Zietman A, Myerson R, Dawson LA, Willett C, Kachnic LA, Jhingran A, Portelance L, Ryu J, Small W, Gaffney D, Viswanathan AN, Michalski JM: Pelvic normal tissue contouring guidelines for radiation therapy: a radiation therapy Oncology Group Consensus Panel Atlas. Int J Radiat Oncol Biol Phys. 2012, 83 (3): e353-e362. 10.1016/j.ijrobp.2012.01.023. Michalski JM, Gay H, Jackson A, Tucker SL, Deasy JO: Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys. 2010, 76: S123-S129. 10.1016/j.ijrobp.2009.03.078. Viswanathan AN, Yorke ED, Marks LB, Eifel PJ, Shipley WU: Radiation dose-volume effects of the urinary bladder. Int J Radiat Oncol Biol Phys. 2010, 76: S116-S122. 10.1016/j.ijrobp.2009.02.090. Dzierma Y, Licht N, Nuesken F, Ruebe C: Beam properties and stability of a flattening-filter-free 7 MV beam–an overview. Med Phys. 2012, 39 (5): 2595-2602. 10.1118/1.3703835. Paddick I: A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg. 2000, 93 (Supp 3): 219-222. Dzierma Y, Nuesken FG, Fleckenstein J, Melchior P, Licht NP, Rübe C: Comparative planning of flattening-filter-free and flat beam IMRT for hypopharynx cancer as a function of beam and segment number. PLoS One. 2014, 9 (4): e94371-10.1371/journal.pone.0094371. Gasic D, Ohlhues L, Brodin NP, Fog LS, Pommer T, Bangsgaard JP, Af Rosenschöld PM: A treatment planning and delivery comparison of volumetric modulated arc therapy with or without flattening filter for gliomas, brain metastases, prostate, head/neck and early stage lung cancer. Acta Oncol. 2014, 53: 1005-1011. 10.3109/0284186X.2014.925578. Teoh M, Clark CH, Wood K, Whitaker S, Nisbet A: Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol. 2011, 84: 967-996. 10.1259/bjr/22373346. Palma D, Vollans E, James K, Nakano S, Moiseenko V, Shaffer R, McKenzie M, Morris J, Otto K: Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2008, 72: 996-1001. 10.1016/j.ijrobp.2008.02.047. Zhang P, Happersett L, Hunt M, Jackson A, Zelefsky M, Mageras G: Volumetric modulated arc therapy: planning and evaluation for prostate cancer cases. Int J Radiat Oncol Biol Phys. 2010, 76: 1456-1462. 10.1016/j.ijrobp.2009.03.033. Kjaer-Kristoffersen F, Ohlhues L, Medin J, Korreman S: RapidArc volumetric modulated therapy planning for prostate cancer patients. Acta Oncol. 2009, 48: 227-232. 10.1080/02841860802266748. Hardcastle N, Tome WA, Foo K, Miller A, Carolan M, Metcalfe P: Comparison of prostate IMRT and VMAT biologically optimized treatment plans. Med Dosim. 2011, 36: 292-298. 10.1016/j.meddos.2010.06.001. Wolff D, Stieler F, Wlzel G, Lorenz F, Abo-Madyan Y, Mai S, Herskind C, Polednik M, Steil V, Wenz F, Lohr F: Volumetric modulated arc therapy (VMAT) vs. serial tomotherapy, step-and-shoot IMRT and 3D-conformal RT for treatment of prostate cancer. Radiother Oncol. 2009, 93: 226-233. 10.1016/j.radonc.2009.08.011. Yoo S, Wu QJ, Lee WR, Yin FF: Radiotherapy treatment plans with RapidArc for prostate cancer involving seminal vesicles and lymph nodes. Int J Radiat Oncol Biol Phys. 2010, 76: 935-942. 10.1016/j.ijrobp.2009.07.1677. Davidson MTM, Blake SJ, Batchelar DL, Cheung P, Mah K: Assessing the role of volumetric modulated arc therapy (VMAT) relative to IMRT and helical tomotherapy in the management of localized, locally advanced, and post-operative prostate cancer. Int J Radiat Oncol Biol Phys. 2011, 80 (5): 1550-1558. 10.1016/j.ijrobp.2010.10.024. Pasler M, Wirtz H, Lutterbach J: Impact of gantry rotation time on plan quality and dosimetric verification – Volumetric Modulated Arc Therapy (VMAT) vs. Intensity Modulated Radiotherapy (IMRT). Strahlenther Onkol. 2011, 187: 812-819. 10.1007/s00066-011-2263-1. Peters S, Schiefer H, Plasswilm L: A treatment planning study comparing Elekta VMAT aand fixed field IMRT using the varian treatment planning system eclipse. Radiat Oncol. 2014, 9: 153-10.1186/1748-717X-9-153. Bratengeier K, Gainey MB, Flentje M: Fast IMRT by increasing the beam number and reducing the number of segments. Radiat Oncol. 2011, 6: 170-10.1186/1748-717X-6-170. Bortfeld T: The number of beams in IMRT – theoretical investigations and implications for single-arc IMRT. Phys Med Biol. 2010, 55 (1): 83-97. 10.1088/0031-9155/55/1/006. Ost P, Speleeers B, De Meerleer G, De Neve W, Fonteyne V, Villeirs G, De Gersem W: Volumetric arc therapy and intensity-modulated radiotherapy for primary prostate radiotherapy with simultaneous integrated boost to intraprostatic lesion with 6 and 18 MV: a planning comparison study. Int J Radiat Oncol Biol Phys. 2011, 79: 920-926. 10.1016/j.ijrobp.2010.04.025. Sabatino M, Kretschmer M, Zink K, Würschmidt F: The impact of direct aperture optimization on plan quality and efficiency in complex head and neck IMRT. Radiat Oncol. 2012, 7: 7-10.1186/1748-717X-7-7. Tsai CL, Wu JK, Chao HL, Tsai YC, Cheng JC: Treatment and dosimetric advantages between VMAT, IMRT, and helical tomotherapy in prostate cancer. Med Dosim. 2011, 36: 264-271. 10.1016/j.meddos.2010.05.001. Fogarty GB, Ng D, Liu G, Haydu LE, Bhandari N: Volumetric modulated arc therapy is superior to conventional intensity modulated radiotherapy – a comparison among prostate cancer patients treated in an Australian centre. Radiat Oncol. 2011, 6: 108-10.1186/1748-717X-6-108. Rao M, Yang W, Chen F, Sheng K, Ye J, Mehta V, Shepart D, Cao D: Comparison of Elekta VMAT with helical toomotherapy and fixed field IMRT: plan quality, delivery efficiency and accuracy. Med Phys. 2010, 37: 1350-1359. 10.1118/1.3326965. Zwahlen DR, Lang S, Hrbacek J, Glanzmann C, Kloeck S, Najafi Y, Streller T, Studer G, Zaugg K, Luetolf UM: The Use of photon beams of a flattening filter-free linear accelerator for hypofractionated volumetric modulated Arc therapy in localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012, 83 (5): 1655-1660. 10.1016/j.ijrobp.2011.10.019.