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01-02-2016 | Original Article

Tomotherapy PET-guided dose escalation

A dosimetric feasibility study for patients with malignant pleural mesothelioma

Authors: Angelo Maggio, PhD, Claudia Cutaia, PhD, Amalia Di Dia, PhD, Sara Bresciani, PhD, Anna Miranti, PhD, Matteo Poli, PhD, Elena Del Mastro, MD, Elisabetta Garibaldi, MD, Pietro Gabriele, MD, Michele Stasi, PhD

Published in: Strahlentherapie und Onkologie | Issue 2/2016

Abstract

Aim

The aim of this study was to investigate whether a safe escalation of the dose to the pleural cavity and PET/CT-positive areas in patients with unresectable malignant pleural mesothelioma (MPM) is possible using helical tomotherapy (HT).

Material and methods

We selected 12 patients with MPM. Three planning strategies were investigated. In the first strategy (standard treatment), treated comprised a prescribed median dose to the planning target volume (PTV) boost (PTV₁) of 64.5 Gy (range: 56 Gy/28 fractions to 66 Gy/30 fractions) and 51 Gy (range: 50.4 Gy/28 fractions to 54 Gy/30 fractions) to the pleura PTV (PTV₂). Thereafter, for each patient, two dose escalation plans were generated prescribing 62.5 and 70 Gy (2.5 and 2.8 Gy/fraction, respectively) to the PTV₁ and 56 Gy (2.24 Gy/fraction) to the PTV₂, in 25 fractions. Dose–volume histogram (DVH) constraints and normal tissue complication probability (NTCP) calculations were used to evaluate the differences between the plans.

Results

For all plans, the 95 % PTVs received at least 95 % of the prescribed dose. For all patients, it was possible to perform the dose escalation in accordance with the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) constraints for organs at risk (OARs). The average contralateral lung dose was < 8 Gy. NTCP values for OARs did not increase significantly compared with the standard treatment (p > 0.05), except for the ipsilateral lung. For all plans, the lung volume ratio was strongly correlated with the V₂₀, V₃₀, and V₄₀ DVHs of the lung (p < 0.0003) and with the lung mean dose (p < 0.0001).

Conclusion

The results of this study suggest that by using HT it is possible to safely escalate the dose delivery to at least 62.5 Gy in PET-positive areas while treating the pleural cavity to 56 Gy in 25 fractions without significantly increasing the dose to the surrounding normal organs.

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Title: Tomotherapy PET-guided dose escalation
A dosimetric feasibility study for patients with malignant pleural mesothelioma
Authors: Angelo Maggio, PhD
Claudia Cutaia, PhD
Amalia Di Dia, PhD
Sara Bresciani, PhD
Anna Miranti, PhD
Matteo Poli, PhD
Elena Del Mastro, MD
Elisabetta Garibaldi, MD
Pietro Gabriele, MD
Michele Stasi, PhD
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 2/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-015-0901-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Tomotherapy PET-guided dose escalation

A dosimetric feasibility study for patients with malignant pleural mesothelioma

Abstract

Aim

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Aim

Material and methods

Results

Conclusion

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