Feasibility of Dose Painting Using Volumetric Modulated Arc Optimization and Delivery

Overview

Journal Acta Oncol

Specialty Oncology

Date 2010 Sep 14

PMID 20831483

Citations 21

Authors

Stine S Korreman

Silke Ulrich

Steve Bowen

Michael Deveau

Soren M Bentzen

Robert Jeraj

Affiliations

Soon will be listed here.

Abstract

Purpose: Dose painting strategies are limited by optimization algorithms in treatment planning systems and physical constraints of the beam delivery. We investigate dose conformity using the RapidArc optimizer and beam delivery technique. Furthermore, robustness of the plans with respect to positioning uncertainties are evaluated.

Methods: A head & neck cancer patient underwent a [(61)Cu]Cu-ATSM PET/CT-scan. PET-SUVs were converted to prescribed dose with a base dose of 60 Gy, and target mean dose 90 Gy. The voxel-based prescription was converted into 3, 5, 7, 9, and 11 discrete prescription levels. Optimization was performed in Eclipse, varying the following parameters: MLC leaf width (5 mm and 2.5 mm), number of arcs (1 and 2) and collimator rotation (0, 15, 30 and 45 degrees). Dose conformity was evaluated using quality volume histograms (QVHs), and relative volumes receiving within ±5% of prescribed dose (Q(0.95-1.05)). Deliverability was tested using a Delta4(®) phantom. Robustness was tested by shifting the isocenter 1 mm and 2 mm in all directions, and recalculating the dose.

Results: Good conformity was obtained using MLC leaf width 2.5 mm, two arcs, and collimators 45/315 degrees, with Q(0.95-1.05)=92.8%, 91.6%, 89.7% and 84.6%. Using only one arc or increasing the MLC leaf width had a small deteriorating effect of 2-5%. Small changes in collimator angle gave small changes, but large changes in collimator angle gave a larger decrease in plan conformity; for angles of 15 and 0 degrees (two arcs, 2.5 mm leaf width), Q(0.95-1.05) decreased by up to 15%. Consistency between planned and delivered dose was good, with ∼90% of gamma values <1. For 1 mm shift, Q(0.95-1.05) was decreased by 5-15%, while for 2 mm shift, Q(0.95-1.05) was decreased to 55-60%.

Conclusions: Results demonstrate feasibility of planning of prescription doses with multiple levels for dose painting using RapidArc, and plans were deliverable. Robustness to positional error was low.

Citing Articles

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Pang Y, Wang H, Li H Front Oncol. 2022; 11:764665.

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References

Bentzen S . Dose painting and theragnostic imaging: towards the prescription, planning and delivery of biologically targeted dose distributions in external beam radiation oncology. Cancer Treat Res. 2008; 139:41-62. View

Yang Y, Xing L . Optimization of radiotherapy dose-time fractionation with consideration of tumor specific biology. Med Phys. 2006; 32(12):3666-77. DOI: 10.1118/1.2126167. View

Bentzen S . Theragnostic imaging for radiation oncology: dose-painting by numbers. Lancet Oncol. 2005; 6(2):112-7. DOI: 10.1016/S1470-2045(05)01737-7. View

Tanderup K, Olsen D, Grau C . Dose painting: art or science?. Radiother Oncol. 2006; 79(3):245-8. DOI: 10.1016/j.radonc.2006.05.002. View

Bowen S, Flynn R, Bentzen S, Jeraj R . On the sensitivity of IMRT dose optimization to the mathematical form of a biological imaging-based prescription function. Phys Med Biol. 2009; 54(6):1483-501. PMC: 2858011. DOI: 10.1088/0031-9155/54/6/007. View

Levin-Plotnik D, Hamilton R . Optimization of tumour control probability for heterogeneous tumours in fractionated radiotherapy treatment protocols. Phys Med Biol. 2004; 49(3):407-24. DOI: 10.1088/0031-9155/49/3/005. View

Webb S, Nahum A . A model for calculating tumour control probability in radiotherapy including the effects of inhomogeneous distributions of dose and clonogenic cell density. Phys Med Biol. 1993; 38(6):653-66. DOI: 10.1088/0031-9155/38/6/001. View

Ling C, Humm J, Larson S, Amols H, Fuks Z, Leibel S . Towards multidimensional radiotherapy (MD-CRT): biological imaging and biological conformality. Int J Radiat Oncol Biol Phys. 2000; 47(3):551-60. DOI: 10.1016/s0360-3016(00)00467-3. View

Deveau M, Bowen S, Westerly D, Jeraj R . Feasibility and sensitivity study of helical tomotherapy for dose painting plans. Acta Oncol. 2010; 49(7):991-6. PMC: 3040036. DOI: 10.3109/0284186X.2010.500302. View

10.

Flynn R, Bowen S, Bentzen S, Mackie T, Jeraj R . Intensity-modulated x-ray (IMXT) versus proton (IMPT) therapy for theragnostic hypoxia-based dose painting. Phys Med Biol. 2008; 53(15):4153-67. PMC: 2695924. DOI: 10.1088/0031-9155/53/15/010. View

11.

Brahme A, Agren A . Optimal dose distribution for eradication of heterogeneous tumours. Acta Oncol. 1987; 26(5):377-85. DOI: 10.3109/02841868709104364. View

12.

Busk M, Horsman M, Overgaard J . Resolution in PET hypoxia imaging: voxel size matters. Acta Oncol. 2008; 47(7):1201-10. DOI: 10.1080/02841860802307716. View

13.

Thorwarth D, Soukup M, Alber M . Dose painting with IMPT, helical tomotherapy and IMXT: a dosimetric comparison. Radiother Oncol. 2007; 86(1):30-4. DOI: 10.1016/j.radonc.2007.11.003. View

14.

Chao K, Bosch W, Mutic S, Lewis J, Dehdashti F, Mintun M . A novel approach to overcome hypoxic tumor resistance: Cu-ATSM-guided intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2001; 49(4):1171-82. DOI: 10.1016/s0360-3016(00)01433-4. View

15.

Webb S, Evans P, Swindell W, Deasy J . A proof that uniform dose gives the greatest TCP for fixed integral dose in the planning target volume. Phys Med Biol. 1994; 39(11):2091-8. DOI: 10.1088/0031-9155/39/11/018. View

16.

Grau C, Paul Muren L, Hoyer M, Lindegaard J, Overgaard J . Image-guided adaptive radiotherapy - integration of biology and technology to improve clinical outcome. Acta Oncol. 2008; 47(7):1182-5. DOI: 10.1080/02841860802282802. View

17.

Korreman S, Medin J, Kjaer-Kristoffersen F . Dosimetric verification of RapidArc treatment delivery. Acta Oncol. 2008; 48(2):185-91. DOI: 10.1080/02841860802287116. View

18.

Koukourakis M, Bentzen S, Giatromanolaki A, Wilson G, Daley F, Saunders M . Endogenous markers of two separate hypoxia response pathways (hypoxia inducible factor 2 alpha and carbonic anhydrase 9) are associated with radiotherapy failure in head and neck cancer patients recruited in the CHART randomized trial. J Clin Oncol. 2006; 24(5):727-35. DOI: 10.1200/JCO.2005.02.7474. View

19.

Malinen E, Sovik A, Hristov D, Bruland O, Olsen D . Adapting radiotherapy to hypoxic tumours. Phys Med Biol. 2006; 51(19):4903-21. DOI: 10.1088/0031-9155/51/19/012. View

20.

Toma-Dasu I, Dasu A, Brahme A . Dose prescription and optimisation based on tumour hypoxia. Acta Oncol. 2009; 48(8):1181-92. DOI: 10.3109/02841860903188643. View