Top

Published in:

Open Access 01-12-2012 | Research

Stereotactic body radiation therapy for liver tumours using flattening filter free beam: dosimetric and technical considerations

Authors: Pietro Mancosu, Simona Castiglioni, Giacomo Reggiori, Maddalena Catalano, Filippo Alongi, Chiara Pellegrini, Stefano Arcangeli, Angelo Tozzi, Francesca Lobefalo, Antonella Fogliata, Piera Navarria, Luca Cozzi, Marta Scorsetti

Published in: Radiation Oncology | Issue 1/2012

Abstract

Purpose

To report the initial institute experience in terms of dosimetric and technical aspects in stereotactic body radiation therapy (SBRT) delivered using flattening filter free (FFF) beam in patients with liver lesions.

Methods and Materials

From October 2010 to September 2011, 55 consecutive patients with 73 primary or metastatic hepatic lesions were treated with SBRT on TrueBeam using FFF beam and RapidArc technique. Clinical target volume (CTV) was defined on multi-phase CT scans, PET/CT, MRI, and 4D-CT. Dose prescription was 75 Gy in 3 fractions to planning target volume (PTV). Constraints for organs at risk were: 700 cc of liver free from the 15 Gy isodose, D_max < 21 Gy for stomach and duodenum, D_max < 30 Gy for heart, D_{0.1 cc} < 18 Gy for spinal cord, V_{15 Gy} < 35% for kidneys. The dose was downscaled in cases of not full achievement of dose constraints. Daily cone beam CT (CBCT) was performed.

Results

Forty-three patients with a single lesion, nine with two lesions and three with three lesions were treated with this protocol. Target and organs at risk objectives were met for all patients. Mean delivery time was 2.8 ± 1.0 min. Pre-treatment plan verification resulted in a Gamma Agreement Index of 98.6 ± 0.8%. Mean on-line co-registration shift of the daily CBCT to the simulation CT were: -0.08, 0.05 and -0.02 cm with standard deviations of 0.33, 0.39 and 0.55 cm in, vertical, longitudinal and lateral directions respectively.

Conclusions

SBRT for liver targets delivered by means of FFF resulted to be feasible with short beam on time.

Available only for authorised users

Timmerman RD, Kavanagh BD, Cho LC, Papiez L, Xing L: Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol 2007, 25: 947-952. 10.1200/JCO.2006.09.7469CrossRefPubMed

Macdermed DM, Weichselbaum RR, Salama JK: A rationale for the targeted treatment of oligometastases with radiotherapy. J Surg Oncol 2008, 98: 202-206. 10.1002/jso.21102CrossRefPubMed

Schefter TE, Kavanagh BD, Timmerman RD, Cardenes HR, Baron A, Gaspar LE: A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. Int J Radiation Oncol Biol Phys 2005, 62: 1371-1378. 10.1016/j.ijrobp.2005.01.002CrossRef

Katz AW, Carey-Sampson M, Muhs AG, Milano MT, Schell MC, Okunieff P: Hypofractionated stereotactic body radiation therapy (SBRT) for limited hepatic metastases. Int J Radiation Oncology Biol Phys 2007, 67: 793-798. 10.1016/j.ijrobp.2006.10.025CrossRef

Scorsetti M, Fogliata A, Castiglioni S, et al.: Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients. Radiation Oncology 2010, 5: 93. 10.1186/1748-717X-5-93PubMedCentralCrossRefPubMed

Scorsetti M, Navarria P, Alongi F, et al.: Large volume unresectable locally advanced non-small cell lung cancer: acute toxicity and initial outcome results with rapid arc. Radiation Oncology 2010, 5: 94. 10.1186/1748-717X-5-94PubMedCentralCrossRefPubMed

Scorsetti M, Bignardi M, Clivio A, et al.: Volumetric modulation arc radiotherapy compared with static gantry intensity-modulated radiotherapy for malignant pleural mesothelioma tumor: a feasibility study. Int J Radiat Oncol Biol Phys 2010, 77: 942-949. 10.1016/j.ijrobp.2009.09.053CrossRefPubMed

Fogliata A, Bergstrom S, Cafaro I, et al.: Cranio-spinal irradiation with volumetric modulated arc therapy: a multi-institutional treatment experience. Radiotherapy and Oncology 2011, 99: 79-85. 10.1016/j.radonc.2011.01.023CrossRefPubMed

Mancosu P, Cozzi L, Fogliata A, et al.: Collimator angle influence on dose distribution optimization for vertebral metastases using volumetric modulated arc therapy. Med Phys 2010, 37: 4133-4137. 10.1118/1.3462560CrossRefPubMed

10.

Mancosu P, Navarria P, Bignardi M, et al.: Re-irradiation of metastatic spinal cord compression: a feasibility study by volumetric-modulated arc radiotherapy for in-field recurrence creating a dosimetric hole on the central canal. Radiotherapy and Oncology 2010, 94: 67-70. 10.1016/j.radonc.2009.11.010CrossRefPubMed

11.

Fogliata A, Cozzi L, Clivio A, et al.: Preclinical assessment of volumetric modulated arc therapy for total marrow irradiation. Int J Radiat Oncol Biol Phys 2011, 80: 628-636. 10.1016/j.ijrobp.2010.11.028CrossRefPubMed

12.

Mancosu P, Navarria P, Castagna L, et al.: Anatomy driven optimisation strategy for total marrow irradiation with a volumetric modulated arc therapy technique. JACMP 2011, in press.

13.

Scorsetti M, Mancosu P, Navarria P, et al.: Stereotactic body radiation therapy (SBRT) for adrenal metastases: a feasibility study of advanced techniques with modulated photons and protons. Strahlenther Onkol 2011, 187: 238-244. 10.1007/s00066-011-2207-9CrossRefPubMed

14.

Bignardi M, Cozzi L, Fogliata A, Lattuada P, Mancosu P, Navarria P, et al.: Critical appraisal of volumetric modulated arc therapy in stereotactic body radiation therapy for metastases to abdominal lymph nodes. Int J Radiat Oncol Biol Phys 2009, 75: 1570-1577. 10.1016/j.ijrobp.2009.05.035CrossRefPubMed

15.

Bignardi M, Navarria P, Mancosu P, Cozzi L, Fogliata A, Tozzi A, et al.: Clinical outcome of hypofractionated stereotactic radiotherapy for abdominal lymph node metastases. Int J Radiati Oncol Biol Phys Vol 2010, in press.

16.

Scorsetti M, Bignardi M, ALongi F, Fogliata A, Mancosu P, Navarria P, Castiglioni S, Pentimalli S, Tozzi A, Cozzi L: Stereotactic body radiation therapy for abdominal targets using volumetric intensity modulated arc therapy with RapidArc: feasibility and clinical preliminary results. Acta Oncol 2011,50(4):528-38. 10.3109/0284186X.2011.558522CrossRefPubMed

17.

Hrbacek J, Lang S, Klöck S: Comissioning of photon beams of a flattening filter-free linear accelerator and the accuracy of beam modelling using an anisotropic analytical algorithm. Int J Radiat Oncol Biol Phys, in press.

18.

Vassiliev ON, Titt U, Pönisch F, Kry SF, Mohan R, Gillin MT: Dosimetric properties of photon beams from a flattening filter free clinical accelerator. Phys Med Biol 2006, 51: 1907-17. 10.1088/0031-9155/51/7/019CrossRefPubMed

19.

Kry SF, Howell RM, Titt U, Salehpour M, Mohan R, Vassiliev ON: Energy spectra, sources, and shielding considerations for neutrons generated by a flattening filter-free Clinac. Med Phys 2008,35(5):1906-11. 10.1118/1.2905029CrossRefPubMed

20.

Pönisch F, Titt U, Vassiliev ON, Kry SF, Mohan R: Properties of unflattened photon beams shaped by a multileaf collimator. Med Phys 2006,33(6):1738-46. 10.1118/1.2201149CrossRefPubMed

21.

Vassiliev ON, Titt U, Kry SF, Pönisch F, Gillin MT, Mohan R: Monte Carlo study of photon fields from a flattening filter-free clinical accelerator. Med Phys 2006,33(4):820-7. 10.1118/1.2174720CrossRefPubMed

22.

Georg D, Knöös T, McClean B: Current status and future perspective of flattening filter free photon beams. Med Phys 2011,38(3):1280-93. 10.1118/1.3554643CrossRefPubMed

23.

Kragl G, Baier F, Lutz S, Albrich D, Dalaryd M, Kroupa B, Wiezorek T, Knöös T, Georg D: Flattening filter free beams in SBRT and IMRT: dosimetric assessment of peripheral doses. Z Med Phys 2010, in press.

24.

Vassiliev ON, Kry SF, Chang JY, Balter PA, Titt U, Mohan R: Stereotactic radiotherapy for lung cancer using a flattening filter free Clinac. J Appl Clin Med Phys 2009,10(1):2880..CrossRefPubMed

25.

Scorsetti M, Alongi F, Castiglioni S, Clivio A, Fogliata A, Lobefalo F, Mancosu P, Navarria P, Palumbo V, Pellegrini C, Pentimalli S, Reggiori G, Ascolese AM, Roggio A, Arcangeli S, Tozzi A, Vanetti E, Cozzi L: Feasibility and early clinical assessment of flattening filter free (FFF) based stereotactic body radiotherapy (SBRT) treatments. Radiat Oncol 2011, 6: 113. 10.1186/1748-717X-6-113PubMedCentralCrossRefPubMed

26.

Eccles CL, Dawson L, Moseley JL, Brock KK: Intrafraction liver shape variability and impact on GTV position during liver stereotactic radiotherapy using abdominal compression. Int J Radiat Oncol Biol Phys 2011,80(3):938-946. 10.1016/j.ijrobp.2010.08.003PubMedCentralCrossRefPubMed

27.

Reggiori G, Mancosu P, Tozzi A, et al.: Cone beam CT pre- and post-daily treatment for assessing geometrical and dosimetric intrafraction variability during radiotherapy of prostate cancer. J Appl Clin Med Phys 2010, 12: 3371.PubMed

28.

RAS-trial radiofrequency ablation versus stereotactic body radiation therapy for colorectal liver metastases: a randomized trial Available at: http://www.livertumor.dk/RAS-trial.html

29.

Milano MT, Constine LS, Okunieff P: Normal tissue toxicity after small field hypofractionated stereotactic body radiation. Radiation Oncology 2008, 3: 36. 10.1186/1748-717X-3-36PubMedCentralCrossRefPubMed

30.

Van Herk M, Remeijer P, Rasch C, Lebesque JV: The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys 2000,47(4):1121-35. 10.1016/S0360-3016(00)00518-6CrossRefPubMed

31.

Low DA, Harms WB, Mutic S, Purdy JA: A technique for quantitative evaluation of dose distributions. Med Phys 1998, 25: 656-661. 10.1118/1.598248CrossRefPubMed

32.

Reggiori G, Mancosu P, Castiglioni S, et al.: Can volumetric modulated arc therapy with flattening filter free beams play a role in stereotactic body radiotherapy for liver lesions? Med Phys 2012, in press.

Title: Stereotactic body radiation therapy for liver tumours using flattening filter free beam: dosimetric and technical considerations
Authors: Pietro Mancosu
Simona Castiglioni
Giacomo Reggiori
Maddalena Catalano
Filippo Alongi
Chiara Pellegrini
Stefano Arcangeli
Angelo Tozzi
Francesca Lobefalo
Antonella Fogliata
Piera Navarria
Luca Cozzi
Marta Scorsetti
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-7-16

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Stereotactic body radiation therapy for liver tumours using flattening filter free beam: dosimetric and technical considerations

Abstract

Purpose

Methods and Materials

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods and Materials

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2012

Stereotactic iodine-125 brachytherapy for brain tumors: temporary versus permanent implantation

ACR Appropriateness Criteria® Resectable Rectal Cancer

Higher toxicity with 42 Gy in 10 fractions as a total dose for 3D-conformal accelerated partial breast irradiation: results from a dose escalation phase II trial

Dosimetric verification of radiotherapy treatment planning systems in Serbia: national audit

Acute gastrointestinal and genitourinary toxicity of image-guided intensity modulated radiation therapy for prostate cancer using a daily water-filled endorectal balloon

Investigation of the change in marker geometry during respiration motion: a preliminary study for dynamic-multi-leaf real-time tumor tracking