Preclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in Halcyon™ ring gantry linear accelerator
Abstract Aim This study aims to report preclinical validation, and the first clinical treatment of total bone marrow irradiation (TMI) and total bone marrow and lymph nodal irradiation (TMLI) using Volumetric modulated arc therapy in Halcyon-E ring gantry linear accelerator. Preclinical validation...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-022-02109-z |
| _version_ | 1828434532968169472 |
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| author | Tanweer Shahid Sourav Mandal Subhra Snigdha Biswal Arundhati De Mukti Mukherjee Sandipan Roy Chowdhury Anupam Chakrapani Kirubha George Jibak Bhattacharya Prosenjit Soren Tanmoy Ghosh Biplab Sarkar Luca Cozzi |
| author_facet | Tanweer Shahid Sourav Mandal Subhra Snigdha Biswal Arundhati De Mukti Mukherjee Sandipan Roy Chowdhury Anupam Chakrapani Kirubha George Jibak Bhattacharya Prosenjit Soren Tanmoy Ghosh Biplab Sarkar Luca Cozzi |
| author_sort | Tanweer Shahid |
| collection | DOAJ |
| description | Abstract Aim This study aims to report preclinical validation, and the first clinical treatment of total bone marrow irradiation (TMI) and total bone marrow and lymph nodal irradiation (TMLI) using Volumetric modulated arc therapy in Halcyon-E ring gantry linear accelerator. Preclinical validation includes simulation, planning, patient-specific QA, and dry run. Material and method Four patients, two female and two male, with body weights of 116 kg, 52 kg, 64 kg, and 62 kg; with two with chronic myeloid leukemia, one each with acute lymphoblastic leukemia and acute myeloid leukemia (AML) were simulated and planned for TMI/TMLI. Patients were immobilized with a full-body vacuum bag. Head first supine (HFS) and Feet first supine (FFS) CT scans were acquired from head to knee and knee to toe. Planning target volume (PTV) was created with a uniform margin of 6 mm over the total bone marrow/bone marrow + lymph nodes. HFS and FFS PTVs were optimized independently using 6MV unflatten energy for 12 Gy in 6 fractions. Plans were merged to create the resultant dose distribution using a junction bias dose matching technique. The total number of isocenters was ≤ 10 per CT set, and two to four full arcs were used for each isocenter. A junction dose gradient technique was used for dose feathering between arcs between adjacent isocenters. Result Only one female patient diagnosed as AML received the TMLI treatment, while the other three patients dropped out due to clinical complications and comorbidities that developed in the time between simulation and treatment. The result presented has been averaged over all four patients. For PTV, 95% dose was normalised to 95% volume, PTV_V107% receiving 3.3 ± 3.1%. Total lung mean and V12Gy were 1048.6 ± 107.1 cGy and 19.5 ± 12.1%. Maximum lens doses were 489.5 ± 35.5 cGy (left: L) and 497 ± 69.2 cGy (right: R). The mean cardiac and bilateral kidney doses were 921.75 ± 89.2 cGy, 917.9 ± 63.2 cGy (L), and 805.9 ± 9.7 cGy (R). Average Monitor Unit was 7738.25 ± 1056.6. The median number of isocenters was 17(HFS+FFS), average MU/Dose (cGy) ratio per isocenter was 2.28 ± 0.3. Conclusion Halcyon-E ring gantry linear accelerator capable of planning and delivering TMI/TMLI. |
| first_indexed | 2024-12-10T18:51:31Z |
| format | Article |
| id | doaj.art-2badee1ba2064d3d98a5d296fa21ccc4 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-10T18:51:31Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-2badee1ba2064d3d98a5d296fa21ccc42022-12-22T01:37:17ZengBMCRadiation Oncology1748-717X2022-08-0117111110.1186/s13014-022-02109-zPreclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in Halcyon™ ring gantry linear acceleratorTanweer Shahid0Sourav Mandal1Subhra Snigdha Biswal2Arundhati De3Mukti Mukherjee4Sandipan Roy Chowdhury5Anupam Chakrapani6Kirubha George7Jibak Bhattacharya8Prosenjit Soren9Tanmoy Ghosh10Biplab Sarkar11Luca Cozzi12Department of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Hemato Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsDepartment of Radiation Oncology, Apollo Multispeciality HospitalsRadiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer CenterAbstract Aim This study aims to report preclinical validation, and the first clinical treatment of total bone marrow irradiation (TMI) and total bone marrow and lymph nodal irradiation (TMLI) using Volumetric modulated arc therapy in Halcyon-E ring gantry linear accelerator. Preclinical validation includes simulation, planning, patient-specific QA, and dry run. Material and method Four patients, two female and two male, with body weights of 116 kg, 52 kg, 64 kg, and 62 kg; with two with chronic myeloid leukemia, one each with acute lymphoblastic leukemia and acute myeloid leukemia (AML) were simulated and planned for TMI/TMLI. Patients were immobilized with a full-body vacuum bag. Head first supine (HFS) and Feet first supine (FFS) CT scans were acquired from head to knee and knee to toe. Planning target volume (PTV) was created with a uniform margin of 6 mm over the total bone marrow/bone marrow + lymph nodes. HFS and FFS PTVs were optimized independently using 6MV unflatten energy for 12 Gy in 6 fractions. Plans were merged to create the resultant dose distribution using a junction bias dose matching technique. The total number of isocenters was ≤ 10 per CT set, and two to four full arcs were used for each isocenter. A junction dose gradient technique was used for dose feathering between arcs between adjacent isocenters. Result Only one female patient diagnosed as AML received the TMLI treatment, while the other three patients dropped out due to clinical complications and comorbidities that developed in the time between simulation and treatment. The result presented has been averaged over all four patients. For PTV, 95% dose was normalised to 95% volume, PTV_V107% receiving 3.3 ± 3.1%. Total lung mean and V12Gy were 1048.6 ± 107.1 cGy and 19.5 ± 12.1%. Maximum lens doses were 489.5 ± 35.5 cGy (left: L) and 497 ± 69.2 cGy (right: R). The mean cardiac and bilateral kidney doses were 921.75 ± 89.2 cGy, 917.9 ± 63.2 cGy (L), and 805.9 ± 9.7 cGy (R). Average Monitor Unit was 7738.25 ± 1056.6. The median number of isocenters was 17(HFS+FFS), average MU/Dose (cGy) ratio per isocenter was 2.28 ± 0.3. Conclusion Halcyon-E ring gantry linear accelerator capable of planning and delivering TMI/TMLI.https://doi.org/10.1186/s13014-022-02109-zTMITMLITBIHalcyonVMAT |
| spellingShingle | Tanweer Shahid Sourav Mandal Subhra Snigdha Biswal Arundhati De Mukti Mukherjee Sandipan Roy Chowdhury Anupam Chakrapani Kirubha George Jibak Bhattacharya Prosenjit Soren Tanmoy Ghosh Biplab Sarkar Luca Cozzi Preclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in Halcyon™ ring gantry linear accelerator Radiation Oncology TMI TMLI TBI Halcyon VMAT |
| title | Preclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in Halcyon™ ring gantry linear accelerator |
| title_full | Preclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in Halcyon™ ring gantry linear accelerator |
| title_fullStr | Preclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in Halcyon™ ring gantry linear accelerator |
| title_full_unstemmed | Preclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in Halcyon™ ring gantry linear accelerator |
| title_short | Preclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in Halcyon™ ring gantry linear accelerator |
| title_sort | preclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in halcyon™ ring gantry linear accelerator |
| topic | TMI TMLI TBI Halcyon VMAT |
| url | https://doi.org/10.1186/s13014-022-02109-z |
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