scholarly journals Sparing Organs at Risk with Simultaneous Integrated Boost Volumetric Modulated Arc Therapy for Locally Advanced Non-Small Cell Lung Cancer: An Automatic Treatment Planning Study

2020 ◽  
Vol Volume 12 ◽  
pp. 9643-9653
Author(s):  
Daquan Wang ◽  
Jiayun Chen ◽  
Xiaodong Zhang ◽  
Tao Zhang ◽  
Luhua Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Organs At Risk ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Planning Study ◽  
Arc Therapy ◽  
Integrated Boost ◽  
Automatic Treatment

scholarly journals Organ at risks sparing with simultaneous integrated boost volumetric modulated arc therapy for locally advanced non-small lung cancer: an automated treatment planning study

2020 ◽  
Author(s):  
Daquan Wang ◽  
Jiayun Chen ◽  
Xiaodong Zhang ◽  
Tao Zhang ◽  
Luhua Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Spinal Cord ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Arc Therapy ◽  
Integrated Boost

Abstract Background : The technique of simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT) have been widely used in locally advanced non-small cell lung cancer, however, its dosimetric advantages are seldom reported. This study aimed to investigate the dosimetric benefit of SIB-VMAT compared to conventional VMAT plans (C-VMAT). Methods : Forty patients with stage III non-small cell lung cancer in our hospital were randomly selected for the two type prescriptions. SIB-VMAT and C-VMAT plans were generated for each patient with the same optimization parameter by the automatic treatment planning system (TPS). The prescribed dose was 50.4 Gy in 28 fractions to PTV and 59.92 Gy in 28 fractions to PGTV in SIB-VMAT plans, with 60 Gy in 30 fractions to PTV in C-VMAT plans. Dose-volume metrics for the planning target volume, lung, heart, esophagus and spinal cord were recorded. The quality score (S D ) was used to evaluate organ at risks (OARs) protection for two type prescription plans. Results : Conformal coverage of the PGTV/PTV by the 95% of the prescription dose was well achieved in automated plans. SIB-VMAT plans achieved significantly lower S D values than C-VMAT plans (Mean: 0.064±0.106 vs. 0.145±0.181, P=0.001). Obvious reductions in mean dose, V 30 , V 40 and V 50 of total lung were observed in SIB-VMAT plans compared to C-VMAT plans, with median decreased proportions of 6.5%、8.7%、19.6% and 32.1%. Statistically significant decrease in heart V 30 and V 40 were also achieved in SIB-VMAT plans, with median decreased proportions of 26.1% and 38.8%. SIB-VMAT plans achieved significant reductions in the maximum doses to both esophagus and spinal cord. Conclusions : SIB-VMAT technique could lead to a substantial sparing of normal organs, including lung, heart, esophagus and cord, mainly through reducing high and inter-median dose exposure.

Potential benefits of volumetric modulated arc therapy to reduce the incidence of ≥ grade 2 radiation pneumonitis in radiotherapy for locally advanced non-small cell lung cancer patients

2021 ◽  
Author(s):  
Nobuki Imano ◽  
Tomoki Kimura ◽  
Daisuke Kawahara ◽  
Riku Nishioka ◽  
Wataru Fukumoto ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Radiation Pneumonitis ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Conformal Radiation Therapy ◽  
Arc Therapy

Abstract Background The use of volumetric modulated arc therapy is gradually widespread for locally advanced non-small cell lung cancer. The purpose of this study was to identify the factors that caused ≥ grade 2 radiation pneumonitis and evaluate the impact of using volumetric modulated arc therapy on the incidence of ≥ grade 2 radiation pneumonitis by comparing three-dimensional conformal radiation therapy. Methods We retrospectively evaluated 124 patients who underwent radical radiotherapy for locally advanced non-small cell lung cancer in our institution between 2008 and 2019. The following variables were analysed to detect the factors that affected ≥ grade 2 radiation pneumonitis; age, sex, the presence of interstitial lung disease, pulmonary emphysema, tumour location, stage, PTV/lung volume, lung V20Gy, total dose, concurrent chemoradiotherapy, adjuvant immune checkpoint inhibitor, radiotherapy method. Radiation pneumonitis was evaluated using the common terminology criteria for adverse events (version 5.0). Results A total of 84 patients underwent three-dimensional conformal radiation therapy (3D-CRT group) and 40 patients underwent volumetric modulated arc therapy (VMAT group). The cumulative incidence of ≥ grade 2 radiation pneumonitis at 12 months was significantly lower in the VMAT group than in the 3D-CRT group (25% vs. 49.1%). The use of volumetric modulated arc therapy was a significant factor for ≥ grade 2 radiation pneumonitis (HR:0.32, 95% CI: 0.15–0.65, P = 0.0017) in addition to lung V20Gy (≥ 24%, HR:5.72 (95% CI: 2.87–11.4), P < 0.0001) and total dose (≥ 70 Gy, HR:2.64 (95% CI: 1.39–5.03), P = 0.0031) even after adjustment by multivariate analysis. Conclusions We identified factors associated with ≥ grade 2 radiation pneumonitis in radiotherapy for patients with locally advanced non-small cell lung cancer. Volumetric modulated arc therapy has potential benefits to reduce the risk of ≥ grade 2 radiation pneumonitis.

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