Evaluation on Lung Cancer Patients' Adaptive Planning of TomoTherapy Utilising Radiobiological Measures and Planned Adaptive Module

Overview

Journal J Radiother Pract

Publisher Cambridge University Press

Specialty Radiology

Date 2011 Sep 28

PMID 20376282

Authors

Fan-Chi Su

Chengyu Shi

Panayiotis Mavroidis

Prema Rassiah-Szegedi

Niko Papanikolaou

Affiliations

Soon will be listed here.

Abstract

Adaptive radiation therapy is a promising concept that allows individualised, dynamic treatment planning based on feedback of measurements. The TomoTherapy Planned Adaptive application, integrated to the helical TomoTherapy planning system, enables calculation of actual dose delivered to the patient for each treatment fraction according to the pretreatment megavoltage computed tomography (MVCT) scan and image registration. As a result, new fractionation treatment plans are available if correction is necessary. In order to evaluate therealclinicaleffect,biologicaldoseis preferred to physical dose. A biological parameter, biologically effective uniform dose ([Formula: see text]), has the advantages of not only reporting delivered dose but also facilitating the analysis of dose-response relations, which link radiation dose to the clinical effect. Therefore, in this study, four lung patients' adaptive plans were evaluated using the [Formula: see text] in addition to physical doses estimated from the TomoTherapy Planned Adaptive module. Higher complication-free tumour control probability (P(+))(of about 8%) was observed in patients treated with larger dose-per-fraction by using the [Formula: see text] in addition to the physical dose. Moreover, a significant increase of 13.2% in the P(+) for the adaptive TomoTherapy plan in one of the lung cancer patients was also observed, which indicates the clinical benefit of adaptive TomoTherapy.

References

Langen K, Meeks S, Poole D, Wagner T, Willoughby T, Kupelian P . The use of megavoltage CT (MVCT) images for dose recomputations. Phys Med Biol. 2005; 50(18):4259-76. DOI: 10.1088/0031-9155/50/18/002. View

Woodford C, Yartsev S, Dar A, Bauman G, Van Dyk J . Adaptive radiotherapy planning on decreasing gross tumor volumes as seen on megavoltage computed tomography images. Int J Radiat Oncol Biol Phys. 2007; 69(4):1316-22. DOI: 10.1016/j.ijrobp.2007.07.2369. View

Ramsey C, Langen K, Kupelian P, Scaperoth D, Meeks S, Mahan S . A technique for adaptive image-guided helical tomotherapy for lung cancer. Int J Radiat Oncol Biol Phys. 2006; 64(4):1237-44. DOI: 10.1016/j.ijrobp.2005.11.012. View

Mavroidis P, Lind B, Brahme A . Biologically effective uniform dose (D) for specification, report and comparison of dose response relations and treatment plans. Phys Med Biol. 2001; 46(10):2607-30. DOI: 10.1088/0031-9155/46/10/307. View

Mavroidis P, Plataniotis G, Gorka M, Lind B . Comments on 'Reconsidering the definition of a dose-volume histogram'--dose-mass histogram (DMH) versus dose-volume histogram (DVH) for predicting radiation-induced pneumonitis. Phys Med Biol. 2006; 51(24):L43-50. DOI: 10.1088/0031-9155/51/24/L01. View

Kilby W, Sage J, Rabett V . Tolerance levels for quality assurance of electron density values generated from CT in radiotherapy treatment planning. Phys Med Biol. 2002; 47(9):1485-92. DOI: 10.1088/0031-9155/47/9/304. View

Han C, Chen Y, Liu A, Schultheiss T, Wong J . Actual dose variation of parotid glands and spinal cord for nasopharyngeal cancer patients during radiotherapy. Int J Radiat Oncol Biol Phys. 2008; 70(4):1256-62. DOI: 10.1016/j.ijrobp.2007.10.067. View

Mavroidis P, Lind B, van Dijk J, Koedooder K, De Neve W, De Wagter C . Comparison of conformal radiation therapy techniques within the dynamic radiotherapy project 'Dynarad'. Phys Med Biol. 2000; 45(9):2459-81. DOI: 10.1088/0031-9155/45/9/302. View

Rockwell Mackie T, Kapatoes J, Ruchala K, Lu W, Wu C, Olivera G . Image guidance for precise conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2003; 56(1):89-105. DOI: 10.1016/s0360-3016(03)00090-7. View

10.

Song W, Chiu B, Bauman G, Lock M, Rodrigues G, Ash R . Prostate contouring uncertainty in megavoltage computed tomography images acquired with a helical tomotherapy unit during image-guided radiation therapy. Int J Radiat Oncol Biol Phys. 2006; 65(2):595-607. DOI: 10.1016/j.ijrobp.2006.01.049. View

11.

Kallman P, Agren A, Brahme A . Tumour and normal tissue responses to fractionated non-uniform dose delivery. Int J Radiat Biol. 1992; 62(2):249-62. DOI: 10.1080/09553009214552071. View

12.

Song W, Battista J, Van Dyk J . Limitations of a convolution method for modeling geometric uncertainties in radiation therapy: the radiobiological dose-per-fraction effect. Med Phys. 2004; 31(11):3034-45. DOI: 10.1118/1.1810235. View

13.

Mavroidis P, Ferreira B, Papanikotaou N, Svensson R, Kappas C, Lind B . Assessing the difference between planned and delivered intensity-modulated radiotherapy dose distributions based on radiobiological measures. Clin Oncol (R Coll Radiol). 2006; 18(7):529-38. DOI: 10.1016/j.clon.2006.04.007. View

14.

Welsh J, Lock M, Harari P, Tome W, Fowler J, Rockwell Mackie T . Clinical implementation of adaptive helical tomotherapy: a unique approach to image-guided intensity modulated radiotherapy. Technol Cancer Res Treat. 2006; 5(5):465-79. DOI: 10.1177/153303460600500503. View

15.

Siker M, Tome W, Mehta M . Tumor volume changes on serial imaging with megavoltage CT for non-small-cell lung cancer during intensity-modulated radiotherapy: how reliable, consistent, and meaningful is the effect?. Int J Radiat Oncol Biol Phys. 2006; 66(1):135-41. DOI: 10.1016/j.ijrobp.2006.03.064. View

16.

Yan D, Vicini F, Wong J, Martinez A . Adaptive radiation therapy. Phys Med Biol. 1997; 42(1):123-32. DOI: 10.1088/0031-9155/42/1/008. View

17.

Drabik D, Mackenzie M, Fallone G . Quantifying appropriate PTV setup margins: analysis of patient setup fidelity and intrafraction motion using post-treatment megavoltage computed tomography scans. Int J Radiat Oncol Biol Phys. 2007; 68(4):1222-8. DOI: 10.1016/j.ijrobp.2007.04.007. View

18.

Woodford C, Yartsev S, Van Dyk J . Optimization of megavoltage CT scan registration settings for thoracic cases on helical tomotherapy. Phys Med Biol. 2007; 52(15):N345-54. DOI: 10.1088/0031-9155/52/15/N04. View

19.

Mavroidis P, Costa Ferreira B, Shi C, Lind B, Papanikolaou N . Treatment plan comparison between helical tomotherapy and MLC-based IMRT using radiobiological measures. Phys Med Biol. 2007; 52(13):3817-36. DOI: 10.1088/0031-9155/52/13/011. View