Intensity-modulated radiation therapy for pancreatic and prostate cancer using pulsed low-dose rate delivery techniques.

Reirradiation of patients who were previously treated with radiotherapy is vastly challenging. Pulsed low-dose rate (PLDR) external beam radiotherapy has the potential to reduce normal tissue toxicities while providing significant tumor control for recurrent cancers. This work investigates treatment planning techniques for intensity-modulated radiation therapy (IMRT)-based PLDR treatment of various sites, including cases with pancreatic and prostate cancer. A total of 20 patients with clinical recurrence were selected for this study, including 10 cases with pancreatic cancer and 10 with prostate cancer. Large variations in the target volume were included to test the ability of IMRT using the existing treatment planning system and optimization algorithm to deliver uniform doses in individual gantry angles/fields for PLDR treatments. Treatment plans were generated with 10 gantry angles using the step-and-shoot IMRT delivery technique, which can be delivered in 3-minute intervals to achieve an effective low dose rate of 6.7cGy/min. Instead of dose constraints on critical structures, ring structures were mainly used in PLDR-IMRT optimization. In this study, the PLDR-IMRT plans were compared with the PLDR-3-dimensional conformal radiation therapy (3DCRT) plans and the PLDR-RapidArc plans. For the 10 cases with pancreatic cancer that were investigated, the mean planning target volume (PTV) dose for each gantry angle in the PLDR-IMRT plans ranged from 17.6 to 22.4cGy. The maximum doses ranged between 22.9 and 34.8cGy. The minimum doses ranged from 8.2 to 17.5cGy. For the 10 cases with prostate cancer that were investigated, the mean PTV doses for individual gantry angles ranged from 18.8 to 22.6cGy. The maximum doses per gantry angle were between 24.0 and 34.7cGy. The minimum doses per gantry angle ranged from 4.4 to 17.4cGy. A significant reduction in the organ at risk (OAR) dose was observed with the PLDR-IMRT plan when compared with that using the PLDR-3DCRT plan. The volume receiving an 18-Gy (V18) dose for the left and right kidneys was reduced by 10.6% and 12.5%, respectively, for the pancreatic plans. The volume receiving a 45-Gy (V45) dose for the small bowel decreased from 65.3% to 45.5%. For the cases with prostate cancer, the volume receiving a 40-Gy (V40) dose for the bladder and the rectum was reduced significantly by 25.1% and 51.2%, respectively. When compared with the RapidArc technique, the volume receiving a 30-Gy (V30) dose for the left and the right kidneys was lower in the IMRT plans. For most OARs, no significant differences were observed between the PLDR-IMRT and the PLDR-RapidArc plans. These results clearly demonstrated that the PLDR-IMRT plan was suitable for PLDR pancreatic and prostate cancer treatments in terms of the overall plan quality. A significant reduction in the OAR dose was achieved with the PLDR-IMRT plan when compared with that using the PLDR-3DCRT plan. For most OARs, no significant differences were observed between the PLDR-IMRT and the PLDR-RapidArc plans. When compared with the PLDR-3DCRT plan, the PLDR-IMRT plan could provide superior target coverage and normal tissue sparing for PLDR reirradiation of recurrent pancreatic and prostate cancers. The PLDR-IMRT plan is an effective treatment choice for recurrent cancers in most cancer centers.

Li J ，Lang J ，Wang P ，Kang S ，Lin MH ，Chen X ，Chen F ，Guo M ，Chen L ，Ma CM ... -  《-》

SU-E-T-383: Pulsed Low Dose Rate Radiotherapy Using Advanced Treatment Methods: A Novel Technique for Patient Re-Irradiation.

Pulsed low dose-rate radiotherapy (PLDR) re-irradiation has the potential to reduce late normal tissue toxicity while still providing significant tumor control for recurrent cancers. In contrast to conventional treatments delivered at dose-rates of 400-600cGy/min, PLDR treatments deliver 20cGy pulses separated by 3-minute intervals to achieve an effective-dose-rate of 6.7cGy/min. This work aims to investigate the planning strategy and delivery quality of PLDR treatment using IMRT and RapidArc techniques. Twenty cases (10 treated with PLDR IMRT, 10 for evaluation purposes) were recruited in this study including prostate, pancreas, lung, head-and-neck, breast and pelvis. IMRT and the RapidArc treatment plans were generated using the Eclipse TPS. For IMRT treatment, each plan consisted of 10 fields to achieve a daily dose of 200cGy. The breast IMRT and the RapidArc plans consisted of two fields/arcs, respectively (40cGy/plan) and were delivered 5 times. The dose contribution from each field to the planning target volume (PTV) was analyzed to evaluate the feasibility for PLDR treatment. Machine-operation- dose-rate and plan quality was also investigated. Dose delivery accuracy was assessed using a cylindrical diode array. Throughout the six treatment sites, the mean PTV dose ranged from 16.1 to 26.1cGy/arc for RapidArc plans and 10.3 to 36.7cGy/field for IMRT plans. For IMRT, the PTV dose contribution from each field strongly depends on the beam arrangement and optimization parameters. With very low dose for a full rotation (∼ 20cGy/arc), the machine-operation-dose-rate of RapidArc plans significantly affects plan quality and deliverability. A machine-operation-dose-rate of 100 MU/min results in superior delivery accuracy (>97.7% gamma-passing-rate for 3%/3mm criteria) for both IMRT and RapidArc plans. PLDR radiotherapy using IMRT and RapidArc techniques Result in both dosimetric and radiobiological benefits, which may have great potential for those previously-irradiated patients who have historically done poorly.

Lin M ，Price R ，Koren S ，Li J ，Ma C ... -  《-》

Investigation of pulsed low dose rate radiotherapy using dynamic arc delivery techniques.

Ma CM ，Lin MH ，Dai XF ，Koren S ，Klayton T ，Wang L ，Li JS ，Chen L ，Price RA ... -  《-》

Simultaneous beam geometry and intensity map optimization in intensity-modulated radiation therapy.

Lee EK ，Fox T ，Crocker I 《INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS》

Dose comparisons for conformal, IMRT and VMAT prostate plans.

Volumetric-modulated arc therapy (VMAT) is a relatively new treatment technique in radiation therapy. A comparison study of conformal, intensity-modulated radiation therapy (IMRT) and single- and double-arc VMAT plans was undertaken to evaluate the dosimetric impact of this new technology in prostate cases. The research questions were as follows: how does VMAT dosimetry compare with IMRT and conformal plans?; does VMAT increase the volume of bowel receiving lower doses?; are one or two VMAT arcs required for standard prostate cases? Eight prostate cancer and post-prostatectomy patients were randomly selected for this study. Conformal, IMRT and single and double Arc VMAT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 75.6 Gy over a course of 42 fractions to the planning target volume (PTV). The Healthy Tissue Conformity Index and the conformation number results revealed the IMRT and two VMAT techniques to have superior dosimetry to the PTV compared with the conformal plans. The maximum dose delivered to the PTV was significantly higher with the single-arc VMAT technique compared with the conformal or double-arc VMAT plans. There were no significant differences between the planning techniques for the bladder and small bowel dosimetry. However, IMRT and VMAT plans delivered less radiation to the rectum and femoral heads, and a single-arc VMAT plan was optimal for the right femoral head and the two VMAT techniques were optimal to the IMRT plans for the left femoral head. Single- and double-arc VMAT consistently resulted in favourable or slightly superior dosimetry when compared with static gantry IMRT for prostate cases. Both the VMAT techniques and static gantry IMRT resulted in superior critical tissue sparing when compared with conformal plans.

Sale C ，Moloney P 《-》