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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 12/2016

Open Access 01-12-2016 | Original Article

Simultaneous integrated protection

A new concept for high-precision radiation therapy

Authors: Thomas B. Brunner, MD, Ursula Nestle, MD, Sonja Adebahr, MD, Eleni Gkika, MD, Rolf Wiehle, Ph.D., Dimos Baltas, Ph.D., Anca-Ligia Grosu, MD

Published in: Strahlentherapie und Onkologie | Issue 12/2016

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Abstract

Objective

Stereotactic radiotherapy near serial organs at risk (OAR) requires special caution. A novel intensity-modulated radiotherapy (IMRT) prescription concept termed simultaneous integrated protection (SIP) for quantifiable and comparable dose prescription to targets very close to OAR is described.

Materials and methods

An intersection volume of a planning risk volume (PRV) with the total planning target volume (PTV) defined the protection volume (PTVSIP). The remainder of the PTV represented the dominant PTV (PTVdom). Planning was performed using IMRT. Dose was prescribed to PTVdom according to ICRU in 3, 5, 8, or 12 fractions. Constraints to OARs were expressed as absolute and as equieffective doses at 2 Gy (EQD2). Dose to the gross risk volume of an OAR was to respect constraints. Violation of constraints to OAR triggered a planning iteration at increased fractionation. Dose to PTVSIP was required to be as high as possible within the constraints to avoid local relapse.

Results

SIP was applied in 6 patients with OAR being large airways (n = 2) or bowel (n = 4) in 3, 5, 8, and 12 fractions in 1, 3, 1, and 1 patients, respectively. PTVs were 14.5–84.9 ml and PTVSIP 1.8–3.9 ml (2.9–13.4 % of PTV). Safety of the plans was analyzed from the absolute dose–volume histogram (dose to ml). The steepness of dose fall-off could be determined by comparing the dose constraints to the PRVs with those to the OARs (Wilcoxon test p = 0.001). Constraints were respected for the corresponding OARs. All patients had local control at a median 9 month follow-up and toxicity was low.

Conclusion

SIP results in a median dose of ≥100 % to PTV, to achieve high local control and low toxicity. Longer follow-up is required to verify results and a prospective clinical trial is currently testing this new approach in chest and abdomen stereotactic body radiotherapy.
Appendix
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Metadata
Title
Simultaneous integrated protection
A new concept for high-precision radiation therapy
Authors
Thomas B. Brunner, MD
Ursula Nestle, MD
Sonja Adebahr, MD
Eleni Gkika, MD
Rolf Wiehle, Ph.D.
Dimos Baltas, Ph.D.
Anca-Ligia Grosu, MD
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 12/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-016-1057-x

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