Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study
Background and purpose: Organ preservation strategies are increasingly being explored for early rectal cancer. This requires revision of target volumes according to disease stage, as well as new guidelines for treatment planning. We conducted an international, multicentre dose planning study to deve...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-09-01
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| Series: | Technical Innovations & Patient Support in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405632419300101 |
| _version_ | 1828199602439847936 |
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| author | Ane L. Appelt Ellen M. Kerkhof Lars Nyvang Ernst C. Harderwijk Natalie L. Abbott Mark Teo Femke P. Peters Camilla J.S. Kronborg Karen-Lise G. Spindler David Sebag-Montefiore Corrie A.M. Marijnen |
| author_facet | Ane L. Appelt Ellen M. Kerkhof Lars Nyvang Ernst C. Harderwijk Natalie L. Abbott Mark Teo Femke P. Peters Camilla J.S. Kronborg Karen-Lise G. Spindler David Sebag-Montefiore Corrie A.M. Marijnen |
| author_sort | Ane L. Appelt |
| collection | DOAJ |
| description | Background and purpose: Organ preservation strategies are increasingly being explored for early rectal cancer. This requires revision of target volumes according to disease stage, as well as new guidelines for treatment planning. We conducted an international, multicentre dose planning study to develop robust planning objectives for modern radiotherapy of a novel mesorectal-only target volume, as implemented in the STAR-TReC trial (NCT02945566). Materials and methods: The published literature was used to establish relevant dose levels for organ at risk (OAR) plan optimisation. Ten representative patients with early rectal cancer were identified. Treatment scans had mesorectal target volumes as well as bowel cavity, bladder and femoral heads outlined, and were circulated amongst the three participating institutions. Each institution produced plans for short course (SCRT, 5 × 5 Gy) and long course (LCRT, 25 × 2 Gy) treatment, using volumetric modulated arc therapy on different dose planning systems. Optimisation objectives for OARs were established by determining dose metric objectives achievable for ≥90% of plans. Results: Sixty plans, all fulfilling target coverage criteria, were produced. The planning results and literature review suggested optimisation objectives for SCRT: V10Gy < 180 cm3, V18Gy < 110 cm3, V23Gy < 85 cm3 for bowel cavity; V21Gy < 15% and V25Gy < 5% for bladder; and V12.5Gy < 11% for femoral heads. Corresponding objectives for LCRT: V20Gy < 180 cm3, V30Gy < 130 cm3, V45Gy < 90 cm3 for bowel cavity; V35Gy < 22% and V50Gy < 7% for bladder; and V25Gy < 15% for femoral heads. Constraints were validated across all three institutions. Conclusion: We utilized a multicentre planning study approach to develop robust planning objectives for mesorectal radiotherapy for early rectal cancer. Keywords: Rectal neoplasms, Radiotherapy, Intensity-modulated, Organ preservation |
| first_indexed | 2024-04-12T10:58:02Z |
| format | Article |
| id | doaj.art-79548a38b7ac4ac98c50c208f3fa217e |
| institution | Directory Open Access Journal |
| issn | 2405-6324 |
| language | English |
| last_indexed | 2024-04-12T10:58:02Z |
| publishDate | 2019-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Technical Innovations & Patient Support in Radiation Oncology |
| spelling | doaj.art-79548a38b7ac4ac98c50c208f3fa217e2022-12-22T03:36:02ZengElsevierTechnical Innovations & Patient Support in Radiation Oncology2405-63242019-09-01111421Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning studyAne L. Appelt0Ellen M. Kerkhof1Lars Nyvang2Ernst C. Harderwijk3Natalie L. Abbott4Mark Teo5Femke P. Peters6Camilla J.S. Kronborg7Karen-Lise G. Spindler8David Sebag-Montefiore9Corrie A.M. Marijnen10Leeds Institute of Medical Research at St James’s, University of Leeds and Leeds Cancer Centre, St James’s University Hospital, Leeds, UK; Corresponding author at: Leeds Cancer Centre, St James's University Hospital, Bexley Wing, LS9 7BE Leeds, UK.Department of Radiotherapy, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Oncology, Aarhus University Hospital, Aarhus, DenmarkDepartment of Radiotherapy, Leiden University Medical Center, Leiden, the NetherlandsRadiotherapy Trials Quality Assurance Group, Velindre Cancer Centre, Cardiff, UKLeeds Cancer Centre, St James’s University Hospital, Leeds, UKDepartment of Radiotherapy, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Oncology, Aarhus University Hospital, Aarhus, DenmarkDepartment of Oncology, Aarhus University Hospital, Aarhus, DenmarkLeeds Institute of Medical Research at St James’s, University of Leeds and Leeds Cancer Centre, St James’s University Hospital, Leeds, UKDepartment of Radiotherapy, Leiden University Medical Center, Leiden, the NetherlandsBackground and purpose: Organ preservation strategies are increasingly being explored for early rectal cancer. This requires revision of target volumes according to disease stage, as well as new guidelines for treatment planning. We conducted an international, multicentre dose planning study to develop robust planning objectives for modern radiotherapy of a novel mesorectal-only target volume, as implemented in the STAR-TReC trial (NCT02945566). Materials and methods: The published literature was used to establish relevant dose levels for organ at risk (OAR) plan optimisation. Ten representative patients with early rectal cancer were identified. Treatment scans had mesorectal target volumes as well as bowel cavity, bladder and femoral heads outlined, and were circulated amongst the three participating institutions. Each institution produced plans for short course (SCRT, 5 × 5 Gy) and long course (LCRT, 25 × 2 Gy) treatment, using volumetric modulated arc therapy on different dose planning systems. Optimisation objectives for OARs were established by determining dose metric objectives achievable for ≥90% of plans. Results: Sixty plans, all fulfilling target coverage criteria, were produced. The planning results and literature review suggested optimisation objectives for SCRT: V10Gy < 180 cm3, V18Gy < 110 cm3, V23Gy < 85 cm3 for bowel cavity; V21Gy < 15% and V25Gy < 5% for bladder; and V12.5Gy < 11% for femoral heads. Corresponding objectives for LCRT: V20Gy < 180 cm3, V30Gy < 130 cm3, V45Gy < 90 cm3 for bowel cavity; V35Gy < 22% and V50Gy < 7% for bladder; and V25Gy < 15% for femoral heads. Constraints were validated across all three institutions. Conclusion: We utilized a multicentre planning study approach to develop robust planning objectives for mesorectal radiotherapy for early rectal cancer. Keywords: Rectal neoplasms, Radiotherapy, Intensity-modulated, Organ preservationhttp://www.sciencedirect.com/science/article/pii/S2405632419300101 |
| spellingShingle | Ane L. Appelt Ellen M. Kerkhof Lars Nyvang Ernst C. Harderwijk Natalie L. Abbott Mark Teo Femke P. Peters Camilla J.S. Kronborg Karen-Lise G. Spindler David Sebag-Montefiore Corrie A.M. Marijnen Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study Technical Innovations & Patient Support in Radiation Oncology |
| title | Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study |
| title_full | Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study |
| title_fullStr | Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study |
| title_full_unstemmed | Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study |
| title_short | Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study |
| title_sort | robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer a multicentre dose planning study |
| url | http://www.sciencedirect.com/science/article/pii/S2405632419300101 |
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