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• W2600395931 abstract "To investigate three treatment planning strategies to minimize the dosimetric variations due to internal and external anatomical changes in stereotactic radiosurgery (SRS) of L-spine tumors. 11 L-spine SRS patients with extensive gas filling in the bowel in the planning CT or pre-treatment cone beam CT were selected for this study. Three coplanar treatment plans were made to deliver 16Gy to 90% of GTV in one fraction using a treatment planning system: 1) Step and shoot IMRT with 9 beams equally distributed around the patient, 2) step and shoot IMRT with 9 posterior beams every 20 degree, and 3) VMAT with 360 degrees full arcs. Dose was calculated with heterogeneity correction and collapsed cone convolution algorithm. Pre-treatment CBCT was registered to the planning CT with the vertebral body as the alignment focus region. For each patient, the external body and bowel gas were contoured on the planning CT and CBCT. To estimate actual delivered dose while considering patient’s anatomy of the treatment day, the following density overrides were performed on the planning CT. To consider external anatomy change, the CBCT external that was outside of the planning CT external were assigned to density one and the CT external outside the CBCT external were assigned to density zero. To consider the internal anatomy change, bowel gas contour in the planning CT was assigned one and the bowel gas contour transferred from the CBCT was assigned to zero. The mean absolute differences (MAD) between planning and estimated delivery in target coverage (V16Gy), maximum dose (0.03cc of volume, D0.03cc) and 12 Gy received by cauda-equina (V12Gy) were evaluated. The MAD of V16Gy for the GTV was 1.8 ± 1.4% (range: 0.2% – 4.9%), 2.4 ± 1.3% (0.1% – 4.9%) and 2.6 ± 1.3% (0.3% – 5.0%) for posterior, uniform and VMAT plans, respectively. The difference was statistically significant for the posterior vs. VMAT plans (p = 0.049) but not significant for the posterior vs. uniform plans (p=0.174). Cauda-equina MAD of V12Gy was 0.9 ± 1.1% (range: 0.1% - 3.9%), 1.2 ± 1.0% (0.1% – 2.7%) and 0.8 ± 0.8% (0% – 1.8%, p=0.024 comparison to uniform) for posterior, uniform and VMAT plans, respectively. The lower cauda-equina MAD of V12Gy for VMAT was because VMAT plans achieved significantly lower V12Gy in the treatment plans (mean: 4.3 ± 1.4%) than posterior (6.7 ± 1.6%) and uniform (6.8 ± 1.6%) plans (p = 0.003). MAD of D0.03cc was 13.1 ± 8.6 cGy (range: 2 – 31 cGy), 19.2 ± 16 cGy (4 – 53 cGy) and 19.3 ± 16 cGy (0 – 59 cGy) for the posterior, uniform and VMAT plans, respectively. The difference was not statistically significant. The posterior plans were less influenced dosimetrically in tumor coverage by variations in abdominal anatomy but were not superior in terms of cauda-equina sparing." @default.
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• W2600395931 date "2015-11-01" @default.
• W2600395931 modified "2023-09-23" @default.
• W2600395931 title "Dosimetric Impact of Internal and External Anatomical Changes in Stereotactic Radiosurgery (SRS) of L-Spine Tumors: Beam Configuration Matters" @default.
• W2600395931 doi "https://doi.org/10.1016/j.ijrobp.2015.07.1981" @default.
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