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Open Access 01-12-2023 | Radiotherapy | Research

Total marrow lymphoid irradiation IMRT treatment using a novel CT-linac

Authors: Dazhen Jiang, Di Deng, Yu Xiong, Dajiang Wang, Jian Gong, Hongli Zhao, Zhirong Bao, Yongchang Wei, Conghua Xie, Lecheng Jia, Can Liao, Shuo Liu, Hui Liu, Xiaoyong Wang

Published in: European Journal of Medical Research | Issue 1/2023

Abstract

Background

A novel CT-linac (kilovolt fan-beam CT-linac) has been introduced into total marrow and lymphoid irradiation (TMLI) treatment. Its integrated kilovolt fan-beam CT (kV FBCT) can be used not only for image guidance (IGRT) but also to re-calculate the dose.

Purpose

This study reported our clinical routine on performing TMIL treatment on the CT-linac, as well as dose distribution comparison between planned and re-calculated based on IGRT FBCT image sets.

Methods

11 sets of data from 5 male and 6 female patients who had underwent the TMLI treatment with uRT-linac 506c were selected for this study. The planning target volumes consist of all skeletal bones exclusion of the mandible and lymphatic sanctuary sites. A planned dose of 10 Gy was prescribed to all skeletal bones exclusion of the mandible in two fractions and 12 Gy in two fractions was prescribed to lymphatic sanctuary sites. Each TMLI plan contained two sub-plans, one dynamic IMRT for the upper body and the other VMAT for the lower extremity. Two attempts were made to obtain homogeneous dose in the overlapping region, i.e., applying two plans with different isocenters for the treatment of two fractions, and using a dose gradient matching scheme. The CT scans, including planning CT and IGRT FBCT, were stitched to a whole body CT scan for dose distribution evaluation.

Results

The average beam-on time of Planupper is 30.6 min, ranging from 24.9 to 37.5 min, and the average beam-on time of Planlower is 6.3 min, ranging from 5.7 to 8.2 min. For the planned dose distribution, the 94.79% of the PTVbone is covered by the prescription dose of 10 Gy (V10), and the 94.68% of the PTVlymph is covered by the prescription dose of 12 Gy (V12). For the re-calculated dose distribution, the 92.17% of the PTVbone is covered by the prescription dose of 10 Gy (V10), and the 90.07% of the PTVlymph is covered by the prescription dose of 12 Gy (V12). The results showed that there is a significant difference (p < 0.05) between planning V10, V12 and delivery V10, V12. There is no significant difference (p > 0.05) between planned dose and re-calculated dose on selected organs, except for right lens (p < 0.05, Dmax). The actual delivered maximum dose of right lens is apparently larger than the planned dose of it.

Conclusion

TMLI treatment can be performed on the CT-linac with clinical acceptable quality and high efficiency. Evaluation of the recalculated dose on IGRT FBCT suggests the treatment was delivered with adequate target coverage.

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Title: Total marrow lymphoid irradiation IMRT treatment using a novel CT-linac
Authors: Dazhen Jiang
Di Deng
Yu Xiong
Dajiang Wang
Jian Gong
Hongli Zhao
Zhirong Bao
Yongchang Wei
Conghua Xie
Lecheng Jia
Can Liao
Shuo Liu
Hui Liu
Xiaoyong Wang
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Radiotherapy
Published in: European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-023-01380-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Total marrow lymphoid irradiation IMRT treatment using a novel CT-linac

Abstract

Background

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusion

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