Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma
Purpose: To investigate the incorporation of functional lung image-derived low-attenuation area (LAA) based on 4-dimensional computed tomography (4D-CT) in volumetric modulated arc therapy (VMAT) planning for patients with malignant pleural mesothelioma (MPM) after extrapleural pneumonectomy. Method...
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| Format: | Article |
| Language: | English |
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Elsevier
2017-04-01
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| Series: | Advances in Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109417300167 |
| _version_ | 1819195098449051648 |
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| author | Yoshiko Doi, MD Tomoki Kimura, MD, PhD Takeo Nakashima, PhD Yuki Takeuchi, MD Ippei Takahashi, MD Ikuno Nishibuchi, MD, PhD Yuji Murakami, MD, PhD Yasushi Nagata, MD, PhD |
| author_facet | Yoshiko Doi, MD Tomoki Kimura, MD, PhD Takeo Nakashima, PhD Yuki Takeuchi, MD Ippei Takahashi, MD Ikuno Nishibuchi, MD, PhD Yuji Murakami, MD, PhD Yasushi Nagata, MD, PhD |
| author_sort | Yoshiko Doi, MD |
| collection | DOAJ |
| description | Purpose: To investigate the incorporation of functional lung image-derived low-attenuation area (LAA) based on 4-dimensional computed tomography (4D-CT) in volumetric modulated arc therapy (VMAT) planning for patients with malignant pleural mesothelioma (MPM) after extrapleural pneumonectomy.
Methods and materials: Twelve patients with MPM after extrapleural pneumonectomy were included. The primarily affected side was the right in 6 patients and the left in 6 patients. LAA was generated from 4D-CT data according to CT values with a threshold of less than –860 Hounsfield units (HU). Functional lung image was defined as the area where LAA was excluded from contralateral lung image. Two radiation therapy plans were designed: (1) Plan C, conventional VMAT and (2) Plan F, functional VMAT plan based on the functional lung. Both plans were compared in each patient with respect to the following dosimetric parameters: fV20, V20, fV10, V10, fV5, and V5, the percentages of functional or contralateral lung volumes irradiated with >20 Gy, 10 Gy, or 5 Gy, respectively; functional mean lung dose (fMLD) and mean lung dose (MLD), the mean dose to the functional or contralateral lung, respectively; maximum dose to the cord; mean doses to the liver and heart; and planning target volume homogeneity index.
Results: fV5 and MLD were significantly lower in Plan F (fV5, median 57.5% in Plan C vs 38.5% in Plan F, P < .01; MLD, median 7.0 Gy in Plan C vs 6.4 Gy in Plan F, P = .04). fV10, V5, and fMLD were also significantly lower in Plan F. Compared with Plan C, planning target volume homogeneity index and liver, heart, and cord doses were not significantly elevated in Plan F.
Conclusions: Significant reductions in fV5, fV10, fMLD, V5, and MLD were achieved with the functional image guided VMAT plan without negative effects on other factors. LAA-based functional image guided radiation therapy planning in VMAT is a feasible method to spare the functional lung in patients with MPM. |
| first_indexed | 2024-12-23T02:07:21Z |
| format | Article |
| id | doaj.art-25b77d1db1e94534a5174ea59dfc44bf |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-23T02:07:21Z |
| publishDate | 2017-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-25b77d1db1e94534a5174ea59dfc44bf2022-12-21T18:03:51ZengElsevierAdvances in Radiation Oncology2452-10942017-04-012218319110.1016/j.adro.2017.01.011Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesotheliomaYoshiko Doi, MD0Tomoki Kimura, MD, PhD1Takeo Nakashima, PhD2Yuki Takeuchi, MD3Ippei Takahashi, MD4Ikuno Nishibuchi, MD, PhD5Yuji Murakami, MD, PhD6Yasushi Nagata, MD, PhD7Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, JapanDepartment of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, JapanDivision of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, JapanDepartment of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, JapanDepartment of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, JapanDepartment of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, JapanDepartment of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, JapanDepartment of Radiation Oncology, Hiroshima University Hospital, Hiroshima City, JapanPurpose: To investigate the incorporation of functional lung image-derived low-attenuation area (LAA) based on 4-dimensional computed tomography (4D-CT) in volumetric modulated arc therapy (VMAT) planning for patients with malignant pleural mesothelioma (MPM) after extrapleural pneumonectomy. Methods and materials: Twelve patients with MPM after extrapleural pneumonectomy were included. The primarily affected side was the right in 6 patients and the left in 6 patients. LAA was generated from 4D-CT data according to CT values with a threshold of less than –860 Hounsfield units (HU). Functional lung image was defined as the area where LAA was excluded from contralateral lung image. Two radiation therapy plans were designed: (1) Plan C, conventional VMAT and (2) Plan F, functional VMAT plan based on the functional lung. Both plans were compared in each patient with respect to the following dosimetric parameters: fV20, V20, fV10, V10, fV5, and V5, the percentages of functional or contralateral lung volumes irradiated with >20 Gy, 10 Gy, or 5 Gy, respectively; functional mean lung dose (fMLD) and mean lung dose (MLD), the mean dose to the functional or contralateral lung, respectively; maximum dose to the cord; mean doses to the liver and heart; and planning target volume homogeneity index. Results: fV5 and MLD were significantly lower in Plan F (fV5, median 57.5% in Plan C vs 38.5% in Plan F, P < .01; MLD, median 7.0 Gy in Plan C vs 6.4 Gy in Plan F, P = .04). fV10, V5, and fMLD were also significantly lower in Plan F. Compared with Plan C, planning target volume homogeneity index and liver, heart, and cord doses were not significantly elevated in Plan F. Conclusions: Significant reductions in fV5, fV10, fMLD, V5, and MLD were achieved with the functional image guided VMAT plan without negative effects on other factors. LAA-based functional image guided radiation therapy planning in VMAT is a feasible method to spare the functional lung in patients with MPM.http://www.sciencedirect.com/science/article/pii/S2452109417300167Functional imaging4-dimensional computed tomographyimage guided radiation therapy |
| spellingShingle | Yoshiko Doi, MD Tomoki Kimura, MD, PhD Takeo Nakashima, PhD Yuki Takeuchi, MD Ippei Takahashi, MD Ikuno Nishibuchi, MD, PhD Yuji Murakami, MD, PhD Yasushi Nagata, MD, PhD Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma Advances in Radiation Oncology Functional imaging 4-dimensional computed tomography image guided radiation therapy |
| title | Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma |
| title_full | Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma |
| title_fullStr | Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma |
| title_full_unstemmed | Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma |
| title_short | Functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma |
| title_sort | functional image guided radiation therapy planning in volumetric modulated arc therapy for patients with malignant pleural mesothelioma |
| topic | Functional imaging 4-dimensional computed tomography image guided radiation therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2452109417300167 |
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