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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 9/2018

01-09-2018 | Original Article

Non-coplanar VMAT combined with non-uniform dose prescription markedly reduces lung dose in breath-hold lung SBRT

Authors: Dr. Jens Fleckenstein, Judit Boda-Heggemann, Kerstin Siebenlist, Tanya Gudzheva, Natallia Prakofyeva, Frank Lohr, Frederik Wenz, Anna Simeonova-Chergou

Published in: Strahlentherapie und Onkologie | Issue 9/2018

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Abstract

Background and purpose

In this retrospective treatment planning study, the effect of a uniform and non-uniform planning target volume (PTV) dose coverage as well as a coplanar and non-coplanar volumetric modulated arc therapy (VMAT) delivery approach for lung stereotactic body radiation therapy (SBRT) in deep inspiration breath-hold (DIBH) were compared.

Materials and methods

For 46 patients with lesions in the peripheral lungs, three different treatment plans were generated: First, a coplanar 220° VMAT sequence with a uniform PTV dose prescription (UC). Second, a coplanar 220° VMAT treatment plan with a non-uniform dose distribution in the PTV (nUC). Third, a non-coplanar VMAT dose delivery with four couch angles (0°, ±35°, 90°) and a non-uniform prescription (nUnC) was used. All treatment plans were optimized for pareto-optimality with respect to PTV coverage and ipsilateral lung dose. Treatment sequences were delivered on a flattening-filter-free linear accelerator and beam-on times were recorded. Dosimetric comparison between the three techniques was performed.

Results

For the three scenarios (UC, nUC, nUnC), median gross tumor volume (GTV) doses were 63.4 ± 2.5, 74.4 ± 3.6, and 77.9 ± 3.8 Gy, and ipsilateral V10Gy lung volumes were 15.7 ± 6.1, 13.9 ± 4.7, and 12.0 ± 5.1%, respectively. Normal tissue complication probability of the ipsilateral lung was 3.9, 3.1, and 2.8%, respectively. The number of monitor units were 5141 ± 1174, 4104 ± 786, and 3657 ± 710 MU and the corresponding beam-on times were 177 ± 54, 143 ± 29, and 148 ± 26 s.

Conclusion

For SBRT treatments in DIBH, a non-uniform dose prescription in the PTV, combined with a non-coplanar VMAT arc arrangement, significantly spares the ipsilateral lung while increasing dose to the GTV without major treatment time increase.
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Metadata
Title
Non-coplanar VMAT combined with non-uniform dose prescription markedly reduces lung dose in breath-hold lung SBRT
Authors
Dr. Jens Fleckenstein
Judit Boda-Heggemann
Kerstin Siebenlist
Tanya Gudzheva
Natallia Prakofyeva
Frank Lohr
Frederik Wenz
Anna Simeonova-Chergou
Publication date
01-09-2018
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 9/2018
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-018-1316-0

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