Junctioning Longitudinally Adjacent PTVs with Helical TomoTherapy

Irradiation of longitudinally adjacent PTVs with Helical TomoTherapy (HT) may be clinically necessary, for example in treating a recurrent PTV adjacent to a previously-treated volume. In this work, the parameters which influence the cumulative dose distribution resulting from treating longitudinally adjacent PTVs are examined, including field width, pitch, and PTV location. In-phantom dose distributions were calculated for various on- and off-axis cylindrical PTVs and were verified by ion chamber and film measurement. Dose distributions were calculated to cover 95% of the PTV by the prescribed dose (DP) using 25 and 50 mm long HT fields with pitches of either 0.3 or 0.45. These dose distributions where then used to calculate the 3D dose distribution in the junction region between two PTVs. The best junction uniformity was obtained for fields of equal width, with larger fields providing better intra-PTV dose homogeneity than smaller fields. Junctioning fields of different widths resulted in a much larger dose inhomogeneity, but this could be improved significantly by dividing the junction end of the PTV treated with the smaller field into multiple (up to 4) sub-PTVs, with the prescribed dose in each sub-PTV decreasing with proximity to the junction region. This provided a PTV matching with dose homogeneity similar to that achieved when junctioning two PTVs, both irradiated by the 50 mm field, and provided a distribution where 95% of the PTV received at least the prescribed dose, with maximum excursions from prescribed dose varying from -19% to +13%. We conclude that junctioning adjacent PTVs is possible. Treating longitudinally adjacent PTVs with different widths is a challenge, but dose uniformity is improved by breaking PTVs into multiple contiguous sub-PTVs modified to feather (broaden) the effective junctioning region.