Automatic Planning of the Lower Extremities for Total Marrow Irradiation Using Volumetric Modulated Arc Therapy

Overview

Journal Strahlenther Onkol

Specialties Oncology
Radiology

Date 2022 Nov 3

PMID 36326856

Authors

Nicola Lambri

Damiano Dei

Victor Hernandez

Isabella Castiglioni

Elena Clerici

Leonardo Crespi

Chiara De Philippis

Daniele Loiacono

Pierina Navarria

Giacomo Reggiori

Roberto Rusconi

Stefano Tomatis

Stefania Bramanti

Marta Scorsetti

Pietro Mancosu

Affiliations

Soon will be listed here.

Abstract

Purpose: Total marrow (and lymphoid) irradiation (TMI-TMLI) is limited by the couch travel range of modern linacs, which forces the treatment delivery to be split into two plans with opposite orientations: a head-first supine upper-body plan, and a feet-first supine lower extremities plan. A specific field junction is thus needed to obtain adequate target coverage in the overlap region of the two plans. In this study, an automatic procedure was developed for field junction creation and lower extremities plan optimization.

Methods: Ten patients treated with TMI-TMLI at our institution were selected retrospectively. The planning of the lower extremities was performed automatically. Target volume parameters (CTV_J‑V > 98%) at the junction region and several dose statistics (D, D, and D) were compared between automatic and manual plans. The modulation complexity score (MCS) was used to assess plan complexity.

Results: The automatic procedure required 60-90 min, depending on the case. All automatic plans achieved clinically acceptable dosimetric results (CTV_J‑V > 98%), with significant differences found at the junction region, where D and D increased on average by 2.4% (p < 0.03) and 3.0% (p < 0.02), respectively. Similar plan complexity was observed (median MCS = 0.12). Since March 2022, the automatic procedure has been introduced in our clinic, reducing the TMI-TMLI simulation-to-delivery schedule by 2 days.

Conclusion: The developed procedure allowed treatment planning of TMI-TMLI to be streamlined, increasing efficiency and standardization, preventing human errors, while maintaining the dosimetric plan quality and complexity of manual plans. Automated strategies can simplify the future adoption and clinical implementation of TMI-TMLI treatments in new centers.

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