Solution for Processing Pelvic Bone Metastases with Halcyon TM 2.0 on Lateral and Longitudinal Isocenters Treatment Plans Using the VMAT Technique: A Comparative Study

Document Type : Original Paper

Authors

1 Department of physics, Faculty of sciences, University Mohammed V in Rabat, Morocco

2 Mohammed VI University of Health Sciences, Casablanca, Morocco

3 Iba Dosimetry Schwarzenbruck, Germany

4 Faculty of Sciences, LPHE-M&S, Mohammed V University, Rabat

5 Université Mohammed V de Rabat

6 Hassan First University of Settat, High Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Settat, Morocco

7 Departement of Physics, Laboratory of High Energy Physics, Modelling and Simulation, Faculty of Science, Mohammed V Agdal University, Rabat, Kingdom of Morocco

8 1Department of physics, Faculty of sciences, University Mohammed V in Rabat, Morocco

Abstract

Introduction: Treatment of pelvic bone metastases using a Halcyon machine, mostly presents some difficulties to plan, especially for big volumes because of the machine field size. The purpose of this study is to use two lateral isocenters in the treatment of pelvic bone metastases with the Halcyon machine, in order to overcome its limitations in treating large volumes.
Material and Methods: We report a retrospective study of 8 patients who received radiotherapy for pelvic bone metastases, all treated by two different VMAT techniques. The first technique was performed by two longitudinal isocenters (LONI) and the second by two lateral isocenters (LATI) respecting the authorized distance longitudinally between two isocenters which must be less than 8 cm. For each isocenter, two opposite arcs are used for all treated patients.
Results: The plans conformity index (CI) assessment shows no difference between the two used techniques for all the treated patients. Remarkable coverage of PTVs was obtained in lateral isocenter (LATI) with 96.2% compared to 94%.6% for LONI, as well as the maximum dose which was 109.4% for LATI versus 112.3% for LONI. However, the Conformation number (CN) that takes into account both healthy tissue and organ at risk protection was improved by 7.3% by using LATI.
Conclusion: A very satisfactory result has been obtained in the treatment of pelvic bone metastases with LATI. With this technique, we can exceed the limits of the Halcyon machine and process larger volumes.

Keywords

Main Subjects

References

  1. 2018 Varian Medical Systems, Inc. RAD 10520A. 2018.
  2. Tsiamas P, Seco J, Han Z, Bhagwat M, Maddox J, Kappas C, et al. A modification of flattening filter free linac for IMRT. Medical physics. 2011 May;38(5):2342-52.
  3. Georg D, Kragl G, Af Wetterstedt S, McCavana P, McClean B, Knöös T. Photon beam quality variations of a flattening filter free linear accelerator. Medical physics. 2010 Jan;37(1):49-53.
  4. Ceberg C, Johnsson S, Lind M, Knöös T. Prediction of stopping‐power ratios in flattening‐filter free beams. Medical physics. 2010 Mar;37(3):1164-8.
  5. Kragl G, af Wetterstedt S, Knäusl B, Lind M, McCavana P, Knöös T, et al. Dosimetric characteristics of 6 and 10 MV unflattened photon beams. Radiotherapy and Oncology. 2009 Oct 1;93(1):141-6.
  6. Cashmore J. The characterization of unflattened photon beams from a 6 MV linear accelerator. Physics in Medicine & Biology. 2008 Mar 11;53(7):1933.
  7. Titt U, Vassiliev ON, Pönisch F, Kry SF, Mohan R. Monte Carlo study of backscatter in a flattening filter free clinical accelerator. Medical physics. 2006 Sep;33(9):3270-3.
  8. Zhu XR, Kang Y, Gillin MT. Measurements of in‐air output ratios for a linear accelerator with and without the flattening filter. Medical physics. 2006 Oct;33(10):3723-33.
  9. Pönisch F, Titt U, Vassiliev ON, Kry SF, Mohan R. Properties of unflattened photon beams shaped by a multileaf collimator. Medical physics. 2006 Jun;33(6Part1):1738-46.
  10. Vassiliev ON, Titt U, Pönisch F, Kry SF, Mohan R, Gillin MT. Dosimetric properties of photon beams from a flattening filter free clinical accelerator. Physics in Medicine & Biology. 2006 Mar 22;51(7):1907.
  11. Titt U, Vassiliev ON, Pönisch F, Dong L, Liu H, Mohan R. A flattening filter free photon treatment concept evaluation with Monte Carlo. Medical physics. 2006 Jun;33(6Part1):1595-602.
  12. Feng Z, Yue H, Zhang Y, Wu H, Cheng J, Su X. Monte Carlo simulation of beam characteristics from small fields based on TrueBeam flattening-filter-free mode. Radiation Oncology. 2016 Dec;11:1-9.
  13. Ding GX, Munro P. Radiation exposure to patients from image guidance procedures and techniques to reduce the imaging dose. Radiotherapy and Oncology. 2013 Jul 1;108(1):91-8.
  14. Fiveash JB, Murshed H, Duan J, Hyatt M, Caranto J, Bonner JA, Popple RA. Effect of multileaf collimator leaf width on physical dose distributions in the treatment of CNS and head and neck neoplasms with intensity modulated radiation therapy. Medical physics. 2002 Jun;29(6):1116-9.
  15. Hutagalung EU. Metastatic bone disease. Medical Journal of Indonesia. 2004 May 1;13(2):127-31.
  16. Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer treatment reviews. 2001 Jun 1;27(3):165-76.
  17. Cecchini MG, Wetterwald A, Van Der Pluijm G, Thalmann GN. Molecular and biological mechanisms of bone metastasis. EAU Update Series. 2005 Dec 1;3(4):214-26.
  18. Selvaggi G, Scagliotti GV. Management of bone metastases in cancer: a review. Critical reviews in oncology/hematology. 2005 Dec 1;56(3):365-78.
  19. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. pain. 2005 Jan 1;113(1):9-19.
  20. McQuay H. Consensus on outcome measures for chronic pain trials. Pain. 2005 Jan 1;113(1):1-2.
  21. He J, Zeng ZC, Tang ZY, Fan J, Zhou J, Zeng MS, et al. Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma receiving external beam radiotherapy. Cancer. 2009 Jun 15;115(12):2710-20.
  22. Chang UK, Kim MS, Han CJ, Lee DH. Clinical result of stereotactic radiosurgery for spinal metastasis from hepatocellular carcinoma: comparison with conventional radiation therapy. Journal of neuro-oncology. 2014 Aug;119:141-8.
  23. Choi C, Seong J. Predictive factors of palliative radiotherapy response and survival in patients with spinal metastases from hepatocellular carcinoma. Gut and liver. 2015 Jan;9(1):94.
  24. Choi Y, Kim JW, Lee IJ, Han HJ, Baek J, Seong J. Helical tomotherapy for spine oligometastases from gastrointestinal malignancies. Radiation oncology journal. 2011 Dec;29(4):219.
  25. Uehara T, Monzen H, Tamura M, Inada M, Otsuka M, Doi H, Matsumoto K, Nishimura Y. Feasibility study of volumetric modulated arc therapy with Halcyon™ linac for total body irradiation. Radiation Oncology. 2021 Dec;16:1-8.
  26. Hui SK, Kapatoes J, Fowler J, Henderson D, Olivera G, Manon RR, et al. Feasibility study of helical tomotherapy for total body or total marrow irradiation a. Medical physics. 2005 Oct;32(10):3214-24.
  27. Fogliata A, Cozzi L, Clivio A, Ibatici A, Mancosu P, Navarria P, et al. Preclinical assessment of volumetric modulated arc therapy for total marrow irradiation. International Journal of Radiation Oncology* Biology* Physics. 2011 Jun 1;80(2):628-36.
  28. Aydogan B, Yeginer M, Kavak GO, Fan J, Radosevich JA, Gwe-Ya K. Total marrow irradiation with RapidArc volumetric arc therapy. International Journal of Radiation Oncology* Biology* Physics. 2011 Oct 1;81(2):592-9.
  29. Miralbell R, Rouzaud M, Grob E, Nouet P, Bieri S, Majno SB, et al. Can a total body irradiation technique be fast and reproducible?. International Journal of Radiation Oncology* Biology* Physics. 1994 Jul 30;29(5):1167-73.
  30. Wong JY, Liu A, Schultheiss T, Popplewell L, Stein A, Rosenthal J, et al. Targeted total marrow irradiation using three-dimensional image-guided tomographic intensity-modulated radiation therapy: an alternative to standard total body irradiation. Biology of Blood and Marrow Transplantation. 2006 Mar 1;12(3):306-15.
  31. Aydogan B, Mundt AJ, Roeske JC. Linac-based intensity modulated total marrow irradiation (IM-TMI). Technology in cancer research & treatment. 2006 Oct;5(5):513-9.
  32. Wilkie JR, Tiryaki H, Smith BD, Roeske JC, Radosevich JA, Aydogan B. Feasibility study for linac‐based intensity modulated total marrow irradiation. Medical physics. 2008 Dec;35(12):5609-18.
  33. Karthik V, Osman S, Singh S, Jassal K, Sarkar B, Ganesh T, et al. Utilization of OSLD as the quality control indicator for in-vivo measurements in total body irradiation. Journal of Medical Physics. 2017;42(suppl. 1):241.
  34. Grégoire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk JA, et al. Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiotherapy and Oncology. 2014 Jan 1;110(1):172-81.
  35. Brouwer CL, Steenbakkers RJ, Bourhis J, Budach W, Grau C, Grégoire V, et al. CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiotherapy and Oncology. 2015 Oct 1;117(1):83-90.
  36. Kataria T, Sharma K, Subramani V, Karrthick KP, Bisht SS. Homogeneity Index: An objective tool for assessment of conformal radiation treatments. Journal of medical physics. 2012 Oct 1;37(4):207-13.
  37. Yoon M, Park SY, Shin D, Lee SB, Pyo HR, Kim DY, et al. A new homogeneity index based on statistical analysis of the dose–volume histogram. Journal of applied clinical medical physics. 2007 Mar;8(2):9-17.
  38. Georges N, Jean-Jacques M, Pierre B. Conformity index: A review. Int J Radiation Oncology Biol Phys. 2006; 64(2):333–
  39. Richmond ND, Turner RN, Dowes PJDK, et al. Evaluation of the dosimetric consequences of adding a single asymmetric or MLC shaped field to a tangential breast radiotherapy technique. Radio Oncol. 2003; 67:165-70.
  40. Van't Riet A, Mak AC, Moerland MA, Elders LH, Van Der Zee W. A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: application to the prostate. International Journal of Radiation Oncology* Biology* Physics. 1997 Feb 1;37(3):731-6.
  41. Dejean C, Lefkopoulos D, Foulquier JN, Schlienger M, Touboul E. Automatic definition of prescription isodose for stereotaxic radiation of arteriovenous malformations. Cancer Radiotherapie: Journal de la Societe Francaise de Radiotherapie Oncologique. 2001 Apr 1;5(2):138-49.
  42. Lomax NJ, Scheib SG. Quantifying the degree of conformity in radiosurgery treatment planning. International Journal of Radiation Oncology* Biology* Physics. 2003 Apr 1;55(5):1409-19.
  43. Shahid T, Mandal S, Biswal SS, De A, Mukherjee M, Roy Chowdhury S, et al. Preclinical validation and treatment of volumetric modulated arc therapy based total bone marrow irradiation in Halcyon™ ring gantry linear accelerator. Radiation Oncology. 2022 Aug 19;17(1):145.
  44. WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents; World Health Organization: Geneva, Switzerland, 2018; ISBN 978-92-4-155039-0.
  45. Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, et al. Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. International Journal of Radiation Oncology* Biology* Physics. 2011 Mar 15;79(4):965-76.

 

 

 

 

 

Iranian Journal of Medical Physics
Volume 21, Issue 4 - Serial Number 4
July and August 2024
Pages 228-236

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History

  • Receive Date: 25 January 2023
  • Revise Date: 05 July 2023
  • Accept Date: 12 July 2023

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