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• W2021636043 abstract "Purpose/Objective(s)The theoretical basis for the optimization of IMRT plans that are robust to positional uncertainties have been reported, most notably for lung cancer. Rather than relying on margins to ensure target coverage, robust methods compensate for a target moving partially outside of the treatment field by increasing the dose delivered on that field, thereby ensuring adequate target coverage while sparing healthy tissues better. In the lung, this loss of coverage is further exacerbated by reduced doses at the periphery of lung tumors due to tissue heterogeneity. We propose a simple planning technique to apply the principles of robust planning to lung cancer radiation therapy.Materials/MethodsFour patients with 4DCT planning scans were randomly chosen and re-planned using both a conventional IMRT and a simple robust approach, using identical beam arrangements. The conventional IMRT plan attempted to cover the PTV accounting for the full extent of tumor motion as defined by the planning 4DCT [PTVconv]. The robust approach consisted of defining a PTV only on the exhale phase of breathing [PTVexh], but compensating for intra-fraction tumor motion and tissue heterogeneity by increasing the dose by 10% to specific parts of the PTVexh: (i) projecting the parts of the PTVconv that fall outside of the PTVexh onto the PTVexh and (ii) any part of the PTVexh intersecting with normal lung tissue. Both plans were normalized to identical ITV coverage. Dose accumulation in deformable and movable target and lung voxels was performed, based on multiple phases from the planning 4DCT data set, using research software (Orbit Workstation, Raysearch Laboratories).ResultsTumor motion ranged from 2 to 10 mm in the cranio-caudal direction. For three patients, the accumulated dose to the ipsilateral lung was lower in the robust plan; on average, V20 decreased by 3.0% [2.3% to 4.0%], V10 decreased by 2.9% [1.0% to 5.2%], and V5 decreased by 3.2% [0.9% to 5.6%]. For the fourth patient, the robust plan increased V20 by 5.1%, V10 by 3.4%, and V5 by 0.2%. For all cases, the accumulated dose to CTV was increased, in the robust plan, by 3.3 Gy [0.6 Gy to 5.2 Gy]. The accumulated CTV dose in robust plans was always at the prescription dose level or higher; conventional plans only achieved this in one case.ConclusionsAccumulating dose provides a better estimate of the dose actually delivered for lung patients, where intra-fraction tumor motion can be significant. Compensating for tumor motion and for heterogeneities by increasing dose to specific areas of the PTVexh may improve tumor coverage while keeping normal lung relatively unaffected, and may provide a means to further escalate dose in conventional lung cancer radiation therapy. Purpose/Objective(s)The theoretical basis for the optimization of IMRT plans that are robust to positional uncertainties have been reported, most notably for lung cancer. Rather than relying on margins to ensure target coverage, robust methods compensate for a target moving partially outside of the treatment field by increasing the dose delivered on that field, thereby ensuring adequate target coverage while sparing healthy tissues better. In the lung, this loss of coverage is further exacerbated by reduced doses at the periphery of lung tumors due to tissue heterogeneity. We propose a simple planning technique to apply the principles of robust planning to lung cancer radiation therapy. The theoretical basis for the optimization of IMRT plans that are robust to positional uncertainties have been reported, most notably for lung cancer. Rather than relying on margins to ensure target coverage, robust methods compensate for a target moving partially outside of the treatment field by increasing the dose delivered on that field, thereby ensuring adequate target coverage while sparing healthy tissues better. In the lung, this loss of coverage is further exacerbated by reduced doses at the periphery of lung tumors due to tissue heterogeneity. We propose a simple planning technique to apply the principles of robust planning to lung cancer radiation therapy. Materials/MethodsFour patients with 4DCT planning scans were randomly chosen and re-planned using both a conventional IMRT and a simple robust approach, using identical beam arrangements. The conventional IMRT plan attempted to cover the PTV accounting for the full extent of tumor motion as defined by the planning 4DCT [PTVconv]. The robust approach consisted of defining a PTV only on the exhale phase of breathing [PTVexh], but compensating for intra-fraction tumor motion and tissue heterogeneity by increasing the dose by 10% to specific parts of the PTVexh: (i) projecting the parts of the PTVconv that fall outside of the PTVexh onto the PTVexh and (ii) any part of the PTVexh intersecting with normal lung tissue. Both plans were normalized to identical ITV coverage. Dose accumulation in deformable and movable target and lung voxels was performed, based on multiple phases from the planning 4DCT data set, using research software (Orbit Workstation, Raysearch Laboratories). Four patients with 4DCT planning scans were randomly chosen and re-planned using both a conventional IMRT and a simple robust approach, using identical beam arrangements. The conventional IMRT plan attempted to cover the PTV accounting for the full extent of tumor motion as defined by the planning 4DCT [PTVconv]. The robust approach consisted of defining a PTV only on the exhale phase of breathing [PTVexh], but compensating for intra-fraction tumor motion and tissue heterogeneity by increasing the dose by 10% to specific parts of the PTVexh: (i) projecting the parts of the PTVconv that fall outside of the PTVexh onto the PTVexh and (ii) any part of the PTVexh intersecting with normal lung tissue. Both plans were normalized to identical ITV coverage. Dose accumulation in deformable and movable target and lung voxels was performed, based on multiple phases from the planning 4DCT data set, using research software (Orbit Workstation, Raysearch Laboratories). ResultsTumor motion ranged from 2 to 10 mm in the cranio-caudal direction. For three patients, the accumulated dose to the ipsilateral lung was lower in the robust plan; on average, V20 decreased by 3.0% [2.3% to 4.0%], V10 decreased by 2.9% [1.0% to 5.2%], and V5 decreased by 3.2% [0.9% to 5.6%]. For the fourth patient, the robust plan increased V20 by 5.1%, V10 by 3.4%, and V5 by 0.2%. For all cases, the accumulated dose to CTV was increased, in the robust plan, by 3.3 Gy [0.6 Gy to 5.2 Gy]. The accumulated CTV dose in robust plans was always at the prescription dose level or higher; conventional plans only achieved this in one case. Tumor motion ranged from 2 to 10 mm in the cranio-caudal direction. For three patients, the accumulated dose to the ipsilateral lung was lower in the robust plan; on average, V20 decreased by 3.0% [2.3% to 4.0%], V10 decreased by 2.9% [1.0% to 5.2%], and V5 decreased by 3.2% [0.9% to 5.6%]. For the fourth patient, the robust plan increased V20 by 5.1%, V10 by 3.4%, and V5 by 0.2%. For all cases, the accumulated dose to CTV was increased, in the robust plan, by 3.3 Gy [0.6 Gy to 5.2 Gy]. The accumulated CTV dose in robust plans was always at the prescription dose level or higher; conventional plans only achieved this in one case. ConclusionsAccumulating dose provides a better estimate of the dose actually delivered for lung patients, where intra-fraction tumor motion can be significant. Compensating for tumor motion and for heterogeneities by increasing dose to specific areas of the PTVexh may improve tumor coverage while keeping normal lung relatively unaffected, and may provide a means to further escalate dose in conventional lung cancer radiation therapy. Accumulating dose provides a better estimate of the dose actually delivered for lung patients, where intra-fraction tumor motion can be significant. Compensating for tumor motion and for heterogeneities by increasing dose to specific areas of the PTVexh may improve tumor coverage while keeping normal lung relatively unaffected, and may provide a means to further escalate dose in conventional lung cancer radiation therapy." @default.
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• W2021636043 date "2008-09-01" @default.
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• W2021636043 title "A Simple, Robust IMRT Optimization Method for Lung Cancer, Accounting for Tissue Heterogenity and Intra-fraction Lung Tumor Motion" @default.
• W2021636043 doi "https://doi.org/10.1016/j.ijrobp.2008.06.963" @default.
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