Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2018

Open Access 01-12-2018 | Research

Automated VMAT planning for postoperative adjuvant treatment of advanced gastric cancer

Authors: Abdul Wahab M. Sharfo, Florian Stieler, Oskar Kupfer, Ben J. M. Heijmen, Maarten L. P. Dirkx, Sebastiaan Breedveld, Frederik Wenz, Frank Lohr, Judit Boda-Heggemann, Daniel Buergy

Published in: Radiation Oncology | Issue 1/2018

Login to get access

Abstract

Background

Postoperative/adjuvant radiotherapy of advanced gastric cancer involves a large planning target volume (PTV) with multi-concave shapes which presents a challenge for volumetric modulated arc therapy (VMAT) planning. This study investigates the advantages of automated VMAT planning for this site compared to manual VMAT planning by expert planners.

Methods

For 20 gastric cancer patients in the postoperative/adjuvant setting, dual-arc VMAT plans were generated using fully automated multi-criterial treatment planning (autoVMAT), and compared to manually generated VMAT plans (manVMAT). Both automated and manual plans were created to deliver a median dose of 45 Gy to the PTV using identical planning and segmentation parameters. Plans were evaluated by two expert radiation oncologists for clinical acceptability. AutoVMAT and manVMAT plans were also compared based on dose-volume histogram (DVH) and predicted normal tissue complication probability (NTCP) analysis.

Results

Both manVMAT and autoVMAT plans were considered clinically acceptable. Target coverage was similar (manVMAT: 96.6 ± 1.6%, autoVMAT: 97.4 ± 1.0%, p = 0.085). With autoVMAT, median kidney dose was reduced on average by > 25%; (for left kidney from 11.3 ± 2.1 Gy to 8.9 ± 3.5 Gy (p = 0.002); for right kidney from 9.2 ± 2.2 Gy to 6.1 ± 1.3 Gy (p <  0.001)). Median dose to the liver was lower as well (18.8 ± 2.3 Gy vs. 17.1 ± 3.6 Gy, p = 0.048). In addition, Dmax of the spinal cord was significantly reduced (38.3 ± 3.7 Gy vs. 31.6 ± 2.6 Gy, p <  0.001). Substantial improvements in dose conformity and integral dose were achieved with autoVMAT plans (4.2% and 9.1%, respectively; p <  0.001). Due to the better OAR sparing in the autoVMAT plans compared to manVMAT plans, the predicted NTCPs for the left and right kidney and the liver-PTV were significantly reduced by 11.3%, 12.8%, 7%, respectively (p ≤ 0.001). Delivery time and total number of monitor units were increased in autoVMAT plans (from 168 ± 19 s to 207 ± 26 s, p = 0.006) and (from 781 ± 168 MU to 1001 ± 134 MU, p = 0.003), respectively.

Conclusions

For postoperative/adjuvant radiotherapy of advanced gastric cancer, involving a complex target shape, automated VMAT planning is feasible and can substantially reduce the dose to the kidneys and the liver, without compromising the target dose delivery.
Appendix
Available only for authorised users
Literature
1.
Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725–30.CrossRefPubMed
2.
Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol. 2012;30:2327–33.CrossRefPubMedPubMedCentral
3.
Zhu WG, Xua DF, Pu J, et al. A randomized, controlled, multicenter study comparing intensity-modulated radiotherapy plus concurrent chemotherapy with chemotherapy alone in gastric cancer patients with D2 resection. Radiother Oncol. 2012;104:361–6.CrossRefPubMed
4.
Lee J, Lim DH, Kim S, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol. 2012;30:268–73.CrossRefPubMed
5.
Park SH, Sohn TS, Lee J, et al. Phase III trial to compare adjuvant chemotherapy with Capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric Cancer: final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses. J Clin Oncol. 2015;33:3130–6.CrossRefPubMed
6.
van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.CrossRefPubMed
7.
Ychou M, Boige V, Pignon JP, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011;29:1715–21.CrossRefPubMed
8.
Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.CrossRefPubMed
9.
Buergy D, Lohr F, Baack T, et al. Radiotherapy for tumors of the stomach and gastroesophageal junction--a review of its role in multimodal therapy. Radiat Oncol. 2012;7:192.CrossRefPubMedPubMedCentral
10.
11.
Boda-Heggemann J, Weiss C, Schneider V, et al. Adjuvant IMRT/XELOX radiochemotherapy improves long-term overall- and disease-free survival in advanced gastric cancer. Strahlenther Onkol. 2013;189:417–23.CrossRefPubMed
12.
Dikken JL, van Sandick JW, Maurits Swellengrebel HA, et al. Neo-adjuvant chemotherapy followed by surgery and chemotherapy or by surgery and chemoradiotherapy for patients with resectable gastric cancer (CRITICS). BMC Cancer. 2011;11:329.CrossRefPubMedPubMedCentral
13.
Berry SL, Boczkowski A, Ma R, Mechalakos J, Hunt M. Interobserver variability in radiation therapy plan output: results of a single-institution study. Pract Radiat Oncol. 2016;6:442–9.CrossRefPubMedPubMedCentral
14.
Appenzoller LM, Michalski JM, Thorstad WL, Mutic S, Moore KL. Predicting dose-volume histograms for organs-at-risk in IMRT planning. Med Phys. 2012;39:7446–61.CrossRefPubMed
15.
Yuan L, Ge Y, Lee WR, Yin FF, Kirkpatrick JP, Wu QJ. Quantitative analysis of the factors which affect the interpatient organ-at-risk dose sparing variation in IMRT plans. Med Phys. 2012;39:6868–78.CrossRefPubMed
16.
Monz M, Kufer KH, Bortfeld TR, Thieke C. Pareto navigation: algorithmic foundation of interactive multi-criteria IMRT planning. Phys Med Biol. 2008;53:985–98.CrossRefPubMed
17.
Breedveld S, Storchi PR, Keijzer M, Heemink AW, Heijmen BJM. A novel approach to multi-criteria inverse planning for IMRT. Phys Med Biol. 2007;52:6339–53.CrossRefPubMed
18.
Breedveld S, Storchi PRM, Voet PWJ, Heijmen BJM. Icycle: integrated, multicriterial beam angle, and profile optimization for generation of coplanar and noncoplanar IMRT plans. Med Phys. 2012;39:951–63.CrossRefPubMed
19.
PWJ V, MLP D, Breedveld S, Al-Mamgani A, Incrocci L, BJM H. Fully automated volumetric modulated arc therapy plan generation for prostate cancer patients. Int J Radiat Oncol Biol Phys. 2014;88:1175–9.CrossRef
20.
Voet PWJ, Dirkx MLP, Breedveld S, Fransen D, Levendag PC, Heijmen BJM. Toward fully automated multicriterial plan generation: a prospective clinical study. Int J Radiat Oncol Biol Phys. 2013;85:866–72.CrossRefPubMed
21.
Sharfo AWM, Breedveld S, Voet PWJ, et al. Validation of fully automated VMAT plan generation for library-based plan-of-the-day cervical cancer radiotherapy. PLoS One. 2016;11:e0169202.CrossRefPubMedPubMedCentral
22.
Della Gala G, Dirkx ML, Hoekstra N, et al. Fully automated VMAT treatment planning for advanced-stage NSCLC patients. Strahlenther Onkol. 2017;193:402–9.CrossRefPubMedPubMedCentral
23.
Li Z, Zeng J, Wang Z, Zhu H, Wei Y. Dosimetric comparison of intensity modulated and volumetric arc radiation therapy for gastric cancer. Oncol Lett. 2014;8:1427–34.CrossRefPubMedPubMedCentral
24.
Zhang T, Liang ZW, Han J, Bi JP, Yang ZY, Ma H. Double-arc volumetric modulated therapy improves dose distribution compared to static gantry IMRT and 3D conformal radiotherapy for adjuvant therapy of gastric cancer. Radiat Oncol. 2015;19:114.CrossRef
25.
Onal C, Dolek Y, Akkus YB. Dosimetric comparison of 3-dimensional conformal radiotherapy, volumetric modulated arc therapy, and helical tomotherapy for postoperative gastric cancer patients. Jpn J Radiol. 2018;36:30–9.CrossRefPubMed
26.
Mondlane G, Gubanski M, Lind PA, Ureba A, Siegbahn A. Comparison of gastric-cancer radiotherapy performed with volumetric modulated arc therapy or single-field uniform-dose proton therapy. Acta Oncol. 2017;56:832–8.CrossRefPubMed
27.
Alber M, Reemtsen R. Intensity modulated radiotherapy treatment planning by use of a barrier-penalty multiplier method. Opt Methods Softw. 2007;22:391–411.CrossRef
28.
Niemierko A. Reporting and analyzing dose distributions: a concept of equivalent uniform dose. Med Phys. 1997;24:103–10.CrossRefPubMed
29.
Dawson LA, Kavanagh BD, Paulino AC, et al. Radiation-associated kidney injury. Int J Radiat Oncol Biol Phys. 2010;76:S108–15.CrossRefPubMed
30.
31.
Dawson LA, Normolle D, Balter JM, McGinn CJ, Lawrence TS, Ten Haken RK. Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys. 2002;53:810–21.CrossRefPubMed
32.
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.CrossRefPubMed
33.
Wong KK, All S, Waxer J, et al. Radiotherapy after high-dose chemotherapy with autologous hematopoietic cell rescue: quality assessment of head start III. Pediatr Blood Cancer. 2017;64:e26529.CrossRef
34.
Wieland P, Dobler B, Mai S, et al. IMRT for postoperative treatment of gastric cancer: covering large target volumes in the upper abdomen: a comparison of a step-and-shoot and an arc therapy approach. Int J Radiat Oncol Biol Phys. 2004;59:1236–44.CrossRefPubMed
35.
Lohr F, Dobler B, Mai S, et al. Optimization of dose distributions for adjuvant locoregional radiotherapy of gastric cancer by IMRT. Strahlenther Onkol. 2003;179:557–63.CrossRefPubMed
36.
Haneder S, Michaely HJ, Schoenberg SO, et al. Assessment of renal function after conformal radiotherapy and intensity-modulated radiotherapy by functional 1H-MRI and 23Na-MRI. Strahlenther Onkol. 2012;188:1146–54.CrossRefPubMed
37.
Kachnic LA, Winter K, Myerson RJ, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys. 2013;86:27–33.CrossRefPubMed
38.
Eisbruch A, Harris J, Garden AS, et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys. 2010;76:1333–8.CrossRefPubMed
39.
Gondi V, Cui Y, Mehta MP, et al. Real-time pretreatment review limits unacceptable deviations on a cooperative group radiation therapy technique trial: quality assurance results of RTOG 0933. Int J Radiat Oncol Biol Phys. 2015;91:564–70.CrossRefPubMedPubMedCentral
40.
Habraken SM, Sharfo AW, Buijsen J, et al. The TRENDY multi-center randomized trial on hepatocellular carcinoma – trial QA including automated treatment planning and benchmark-case results. Radiother Oncol. 2017;125:507–13.CrossRefPubMed
41.
Hussein M, South CP, Barry MA, et al. Clinical validation and benchmarking of knowledge-based IMRT and VMAT treatment planning in pelvic anatomy. Radiother Oncol. 2016;120:473–9.CrossRefPubMed
42.
Fogliata A, Belosi F, Clivio A, et al. On the pre-clinical validation of a commercial model-based optimization engine: application to volumetric modulated arc therapy for patients with lung or prostate cancer. Radiother Oncol. 2014;113:385–91.CrossRefPubMed
43.
Fogliata A, Nicolini G, Clivio A, et al. A broad scope knowledge based model for optimization of VMAT in esophageal cancer: validation and assessment of plan quality among different treatment centers. Radiat Oncol. 2015;10:220.CrossRefPubMedPubMedCentral
Metadata
Title
Automated VMAT planning for postoperative adjuvant treatment of advanced gastric cancer
Authors
Abdul Wahab M. Sharfo
Florian Stieler
Oskar Kupfer
Ben J. M. Heijmen
Maarten L. P. Dirkx
Sebastiaan Breedveld
Frederik Wenz
Frank Lohr
Judit Boda-Heggemann
Daniel Buergy
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-018-1032-z

Other articles of this Issue 1/2018

Radiation Oncology 1/2018 Go to the issue

Research

Response criteria in solid tumors (PERCIST/RECIST) and SUVmax in early-stage non-small cell lung cancer patients treated with stereotactic body radiotherapy

Research

Evaluation of the tumor movement and the reproducibility of two different immobilization setups for image-guided stereotactic body radiotherapy of liver tumors

Research

A novel model to correlate hydrogel spacer placement, perirectal space creation, and rectum dosimetry in prostate stereotactic body radiotherapy

Research

Auto- versus human-driven plan in mediastinal Hodgkin lymphoma radiation treatment

Review

Monte Carlo simulations in radiotherapy dosimetry

Research

Optimization of dose distributions of target volumes and organs at risk during stereotactic body radiation therapy for pancreatic cancer with dose-limiting auto-shells