Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases
Abstract Purpose This study implemented a piecewise volumetric modulated arc therapy (P-VMAT) for realizing whole-brain radiation therapy (WBRT) with simultaneous integrated boost (SIB) for multiple brain metastases (> 40 metastases) with a conventional C-arm linear accelerator. Materials and met...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-022-02059-6 |
| _version_ | 1811304800084557824 |
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| author | Yuan Xu Yingjie Xu Kuo Men Jianping Xiao Jianrong Dai |
| author_facet | Yuan Xu Yingjie Xu Kuo Men Jianping Xiao Jianrong Dai |
| author_sort | Yuan Xu |
| collection | DOAJ |
| description | Abstract Purpose This study implemented a piecewise volumetric modulated arc therapy (P-VMAT) for realizing whole-brain radiation therapy (WBRT) with simultaneous integrated boost (SIB) for multiple brain metastases (> 40 metastases) with a conventional C-arm linear accelerator. Materials and methods This study retrospectively analyzed 10 patients with multiple brain metastases (40–120 metastases, median 76), who underwent WBRT and SIB using helical tomotherapy (HT). The prescribed doses were 40 Gy/20 f and 60 Gy/20 f for WBRT and SIB, respectively. Corresponding new HT plans were designed with P-VMAT using 7 arcs. For each arc, the collimator was rotated to 45°, and the field width was limited to 2.5 cm with 0.5 cm overlap with adjacent arcs. Thus, each arc covered only one section of the brain target volume. A conventional dual arc VMAT (DA-VMAT) plan was also designed. HT, P-VMAT, and DA-VMAT plans were compared using dose distribution reviews and dosimetric parameters. ArcCHECK phantom measurements were performed for verification of P-VMAT plans. Results No significant differences in the mean coverage of the whole-brain target and metastases were observed between HT and P-VMAT (p > 0.05). The conformity index for the whole-brain target improved with P-VMAT compared with HT (p < 0.05). Furthermore, the volume of 44 Gy V44 (110% of prescribed dose for WBRT) received for whole-brain significantly reduced with P-VMAT from 38.2 ± 12.9% to 23.3 ± 9.4% (p < 0.05), and the maximum dose for organs at risks such as the hippocampus, optical nerve, optical chiasm, and spinal cord declined with P-VMAT (p < 0.05). Unlike HT and P-VMAT, DA-VMAT was clinically unacceptable because V44 in the whole-brain was too high (54.7 ± 8.2%). The mean absolute dose gamma passing rate for P-VMAT plans was 97.6 ± 1.1% (3%/3 mm criterion, 10%). Conclusions P-VMAT is favorable for WBRT and SIB for multiple brain metastases. It provides comparable coverage of whole-brain target and SIB, with better conformity, lower V44, and better dose sparing of organs at risk compared with HT. Furthermore, results show that DA-VMAT fails clinical practice even for a relatively large number of brain metastases with a high degree of plan complexity. The patient specific verification demonstrates the feasibility of P-VMAT for clinical application. |
| first_indexed | 2024-04-13T08:13:46Z |
| format | Article |
| id | doaj.art-a20648f97fa742b2a1fcdab72fc07646 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-04-13T08:13:46Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-a20648f97fa742b2a1fcdab72fc076462022-12-22T02:54:52ZengBMCRadiation Oncology1748-717X2022-05-011711910.1186/s13014-022-02059-6Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastasesYuan Xu0Yingjie Xu1Kuo Men2Jianping Xiao3Jianrong Dai4Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeAbstract Purpose This study implemented a piecewise volumetric modulated arc therapy (P-VMAT) for realizing whole-brain radiation therapy (WBRT) with simultaneous integrated boost (SIB) for multiple brain metastases (> 40 metastases) with a conventional C-arm linear accelerator. Materials and methods This study retrospectively analyzed 10 patients with multiple brain metastases (40–120 metastases, median 76), who underwent WBRT and SIB using helical tomotherapy (HT). The prescribed doses were 40 Gy/20 f and 60 Gy/20 f for WBRT and SIB, respectively. Corresponding new HT plans were designed with P-VMAT using 7 arcs. For each arc, the collimator was rotated to 45°, and the field width was limited to 2.5 cm with 0.5 cm overlap with adjacent arcs. Thus, each arc covered only one section of the brain target volume. A conventional dual arc VMAT (DA-VMAT) plan was also designed. HT, P-VMAT, and DA-VMAT plans were compared using dose distribution reviews and dosimetric parameters. ArcCHECK phantom measurements were performed for verification of P-VMAT plans. Results No significant differences in the mean coverage of the whole-brain target and metastases were observed between HT and P-VMAT (p > 0.05). The conformity index for the whole-brain target improved with P-VMAT compared with HT (p < 0.05). Furthermore, the volume of 44 Gy V44 (110% of prescribed dose for WBRT) received for whole-brain significantly reduced with P-VMAT from 38.2 ± 12.9% to 23.3 ± 9.4% (p < 0.05), and the maximum dose for organs at risks such as the hippocampus, optical nerve, optical chiasm, and spinal cord declined with P-VMAT (p < 0.05). Unlike HT and P-VMAT, DA-VMAT was clinically unacceptable because V44 in the whole-brain was too high (54.7 ± 8.2%). The mean absolute dose gamma passing rate for P-VMAT plans was 97.6 ± 1.1% (3%/3 mm criterion, 10%). Conclusions P-VMAT is favorable for WBRT and SIB for multiple brain metastases. It provides comparable coverage of whole-brain target and SIB, with better conformity, lower V44, and better dose sparing of organs at risk compared with HT. Furthermore, results show that DA-VMAT fails clinical practice even for a relatively large number of brain metastases with a high degree of plan complexity. The patient specific verification demonstrates the feasibility of P-VMAT for clinical application.https://doi.org/10.1186/s13014-022-02059-6Piecewise VMATWBRTSIBBrain metastasesHT |
| spellingShingle | Yuan Xu Yingjie Xu Kuo Men Jianping Xiao Jianrong Dai Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases Radiation Oncology Piecewise VMAT WBRT SIB Brain metastases HT |
| title | Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases |
| title_full | Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases |
| title_fullStr | Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases |
| title_full_unstemmed | Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases |
| title_short | Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases |
| title_sort | application of piecewise vmat technique to whole brain radiotherapy with simultaneous integrated boost for multiple metastases |
| topic | Piecewise VMAT WBRT SIB Brain metastases HT |
| url | https://doi.org/10.1186/s13014-022-02059-6 |
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