Circumferential or sectored beam arrangements for stereotactic body radiation therapy (SBRT) of primary lung tumors

Effect on target and normal-structure dose-volume metrics

Mara W. Rosenberg, Catherine M. Kato, Kelly M P Carson, Nathan M. Matsunaga, Robert F. Arao, Emily J. Doss, Charles L. McCracken, Lu Z. Meng, Yiyi Chen, Wolfram Laub, Martin Fuss, James Tanyi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

To compare 2 beam arrangements, sectored (beam entry over ipsilateral hemithorax) vs circumferential (beam entry over both ipsilateral and contralateral lungs), for static-gantry intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) delivery techniques with respect to target and organs-at-risk (OAR) dose-volume metrics, as well as treatment delivery efficiency. Data from 60 consecutive patients treated using stereotactic body radiation therapy (SBRT) for primary non-small-cell lung cancer (NSCLC) formed the basis of this study. Four treatment plans were generated per data set: IMRT/VMAT plans using sectored (-s) and circumferential (-c) configurations. The prescribed dose (PD) was 60Gy in 5 fractions to 95% of the planning target volume (PTV) (maximum PTV dose ~ 150% PD) for a 6-MV photon beam. Plan conformality, R50 (ratio of volume circumscribed by the 50% isodose line and the PTV), and D2cm (Dmax at a distance ≥2cm beyond the PTV) were evaluated. For lungs, mean doses (mean lung dose [MLD]) and percent V30/V20/V10/V5Gy were assessed. Spinal cord and esophagus Dmax and D5/D50 were computed. Chest wall (CW) Dmax and absolute V30/V20/V10/V5Gy were reported. Sectored SBRT planning resulted in significant decrease in contralateral MLD and V10/V5Gy, as well as contralateral CW Dmax and V10/V5Gy (all p <0.001). Nominal reductions of Dmax and D5/D50 for the spinal cord with sectored planning did not reach statistical significance for static-gantry IMRT, although VMAT metrics did show a statistically significant decrease (all p <0.001). The respective measures for esophageal doses were significantly lower with sectored planning (p <0.001). Despite comparable dose conformality, irrespective of planning configuration, R50 significantly improved with IMRT-s/VMAT-c (p <0.001/p = 0.008), whereas D2cm significantly improved with VMAT-c (p <0.001). Plan delivery efficiency improved with sectored technique (p <0.001); mean monitor unit (MU)/cGy of PD decreased from 5.8 ± 1.9 vs 5.3 ± 1.7 (IMRT) and 2.7 ± 0.4 vs 2.4 ± 0.3 (VMAT). The sectored configuration achieves unambiguous dosimetric advantages over circumferential arrangement in terms of esophageal, contralateral CW, and contralateral lung sparing, in addition to being more efficient at delivery.

Original languageEnglish (US)
Pages (from-to)407-412
Number of pages6
JournalMedical Dosimetry
Volume38
Issue number4
DOIs
StatePublished - 2013

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Intensity-Modulated Radiotherapy
Radiotherapy
Lung
Thoracic Wall
Neoplasms
Spinal Cord
Organs at Risk
Photons
Non-Small Cell Lung Carcinoma
Esophagus
Therapeutics

Keywords

  • Beam configuration
  • Intensity-modulated arc therapy
  • Intensity-modulated radiotherapy
  • Stereotactic body radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Circumferential or sectored beam arrangements for stereotactic body radiation therapy (SBRT) of primary lung tumors : Effect on target and normal-structure dose-volume metrics. / Rosenberg, Mara W.; Kato, Catherine M.; Carson, Kelly M P; Matsunaga, Nathan M.; Arao, Robert F.; Doss, Emily J.; McCracken, Charles L.; Meng, Lu Z.; Chen, Yiyi; Laub, Wolfram; Fuss, Martin; Tanyi, James.

In: Medical Dosimetry, Vol. 38, No. 4, 2013, p. 407-412.

Research output: Contribution to journalArticle

Rosenberg, Mara W. ; Kato, Catherine M. ; Carson, Kelly M P ; Matsunaga, Nathan M. ; Arao, Robert F. ; Doss, Emily J. ; McCracken, Charles L. ; Meng, Lu Z. ; Chen, Yiyi ; Laub, Wolfram ; Fuss, Martin ; Tanyi, James. / Circumferential or sectored beam arrangements for stereotactic body radiation therapy (SBRT) of primary lung tumors : Effect on target and normal-structure dose-volume metrics. In: Medical Dosimetry. 2013 ; Vol. 38, No. 4. pp. 407-412.
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abstract = "To compare 2 beam arrangements, sectored (beam entry over ipsilateral hemithorax) vs circumferential (beam entry over both ipsilateral and contralateral lungs), for static-gantry intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) delivery techniques with respect to target and organs-at-risk (OAR) dose-volume metrics, as well as treatment delivery efficiency. Data from 60 consecutive patients treated using stereotactic body radiation therapy (SBRT) for primary non-small-cell lung cancer (NSCLC) formed the basis of this study. Four treatment plans were generated per data set: IMRT/VMAT plans using sectored (-s) and circumferential (-c) configurations. The prescribed dose (PD) was 60Gy in 5 fractions to 95{\%} of the planning target volume (PTV) (maximum PTV dose ~ 150{\%} PD) for a 6-MV photon beam. Plan conformality, R50 (ratio of volume circumscribed by the 50{\%} isodose line and the PTV), and D2cm (Dmax at a distance ≥2cm beyond the PTV) were evaluated. For lungs, mean doses (mean lung dose [MLD]) and percent V30/V20/V10/V5Gy were assessed. Spinal cord and esophagus Dmax and D5/D50 were computed. Chest wall (CW) Dmax and absolute V30/V20/V10/V5Gy were reported. Sectored SBRT planning resulted in significant decrease in contralateral MLD and V10/V5Gy, as well as contralateral CW Dmax and V10/V5Gy (all p <0.001). Nominal reductions of Dmax and D5/D50 for the spinal cord with sectored planning did not reach statistical significance for static-gantry IMRT, although VMAT metrics did show a statistically significant decrease (all p <0.001). The respective measures for esophageal doses were significantly lower with sectored planning (p <0.001). Despite comparable dose conformality, irrespective of planning configuration, R50 significantly improved with IMRT-s/VMAT-c (p <0.001/p = 0.008), whereas D2cm significantly improved with VMAT-c (p <0.001). Plan delivery efficiency improved with sectored technique (p <0.001); mean monitor unit (MU)/cGy of PD decreased from 5.8 ± 1.9 vs 5.3 ± 1.7 (IMRT) and 2.7 ± 0.4 vs 2.4 ± 0.3 (VMAT). The sectored configuration achieves unambiguous dosimetric advantages over circumferential arrangement in terms of esophageal, contralateral CW, and contralateral lung sparing, in addition to being more efficient at delivery.",
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T1 - Circumferential or sectored beam arrangements for stereotactic body radiation therapy (SBRT) of primary lung tumors

T2 - Effect on target and normal-structure dose-volume metrics

AU - Rosenberg, Mara W.

AU - Kato, Catherine M.

AU - Carson, Kelly M P

AU - Matsunaga, Nathan M.

AU - Arao, Robert F.

AU - Doss, Emily J.

AU - McCracken, Charles L.

AU - Meng, Lu Z.

AU - Chen, Yiyi

AU - Laub, Wolfram

AU - Fuss, Martin

AU - Tanyi, James

PY - 2013

Y1 - 2013

N2 - To compare 2 beam arrangements, sectored (beam entry over ipsilateral hemithorax) vs circumferential (beam entry over both ipsilateral and contralateral lungs), for static-gantry intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) delivery techniques with respect to target and organs-at-risk (OAR) dose-volume metrics, as well as treatment delivery efficiency. Data from 60 consecutive patients treated using stereotactic body radiation therapy (SBRT) for primary non-small-cell lung cancer (NSCLC) formed the basis of this study. Four treatment plans were generated per data set: IMRT/VMAT plans using sectored (-s) and circumferential (-c) configurations. The prescribed dose (PD) was 60Gy in 5 fractions to 95% of the planning target volume (PTV) (maximum PTV dose ~ 150% PD) for a 6-MV photon beam. Plan conformality, R50 (ratio of volume circumscribed by the 50% isodose line and the PTV), and D2cm (Dmax at a distance ≥2cm beyond the PTV) were evaluated. For lungs, mean doses (mean lung dose [MLD]) and percent V30/V20/V10/V5Gy were assessed. Spinal cord and esophagus Dmax and D5/D50 were computed. Chest wall (CW) Dmax and absolute V30/V20/V10/V5Gy were reported. Sectored SBRT planning resulted in significant decrease in contralateral MLD and V10/V5Gy, as well as contralateral CW Dmax and V10/V5Gy (all p <0.001). Nominal reductions of Dmax and D5/D50 for the spinal cord with sectored planning did not reach statistical significance for static-gantry IMRT, although VMAT metrics did show a statistically significant decrease (all p <0.001). The respective measures for esophageal doses were significantly lower with sectored planning (p <0.001). Despite comparable dose conformality, irrespective of planning configuration, R50 significantly improved with IMRT-s/VMAT-c (p <0.001/p = 0.008), whereas D2cm significantly improved with VMAT-c (p <0.001). Plan delivery efficiency improved with sectored technique (p <0.001); mean monitor unit (MU)/cGy of PD decreased from 5.8 ± 1.9 vs 5.3 ± 1.7 (IMRT) and 2.7 ± 0.4 vs 2.4 ± 0.3 (VMAT). The sectored configuration achieves unambiguous dosimetric advantages over circumferential arrangement in terms of esophageal, contralateral CW, and contralateral lung sparing, in addition to being more efficient at delivery.

AB - To compare 2 beam arrangements, sectored (beam entry over ipsilateral hemithorax) vs circumferential (beam entry over both ipsilateral and contralateral lungs), for static-gantry intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) delivery techniques with respect to target and organs-at-risk (OAR) dose-volume metrics, as well as treatment delivery efficiency. Data from 60 consecutive patients treated using stereotactic body radiation therapy (SBRT) for primary non-small-cell lung cancer (NSCLC) formed the basis of this study. Four treatment plans were generated per data set: IMRT/VMAT plans using sectored (-s) and circumferential (-c) configurations. The prescribed dose (PD) was 60Gy in 5 fractions to 95% of the planning target volume (PTV) (maximum PTV dose ~ 150% PD) for a 6-MV photon beam. Plan conformality, R50 (ratio of volume circumscribed by the 50% isodose line and the PTV), and D2cm (Dmax at a distance ≥2cm beyond the PTV) were evaluated. For lungs, mean doses (mean lung dose [MLD]) and percent V30/V20/V10/V5Gy were assessed. Spinal cord and esophagus Dmax and D5/D50 were computed. Chest wall (CW) Dmax and absolute V30/V20/V10/V5Gy were reported. Sectored SBRT planning resulted in significant decrease in contralateral MLD and V10/V5Gy, as well as contralateral CW Dmax and V10/V5Gy (all p <0.001). Nominal reductions of Dmax and D5/D50 for the spinal cord with sectored planning did not reach statistical significance for static-gantry IMRT, although VMAT metrics did show a statistically significant decrease (all p <0.001). The respective measures for esophageal doses were significantly lower with sectored planning (p <0.001). Despite comparable dose conformality, irrespective of planning configuration, R50 significantly improved with IMRT-s/VMAT-c (p <0.001/p = 0.008), whereas D2cm significantly improved with VMAT-c (p <0.001). Plan delivery efficiency improved with sectored technique (p <0.001); mean monitor unit (MU)/cGy of PD decreased from 5.8 ± 1.9 vs 5.3 ± 1.7 (IMRT) and 2.7 ± 0.4 vs 2.4 ± 0.3 (VMAT). The sectored configuration achieves unambiguous dosimetric advantages over circumferential arrangement in terms of esophageal, contralateral CW, and contralateral lung sparing, in addition to being more efficient at delivery.

KW - Beam configuration

KW - Intensity-modulated arc therapy

KW - Intensity-modulated radiotherapy

KW - Stereotactic body radiotherapy

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