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• W2896877142 abstract "Re-irradiation with ablative doses to a smaller target volume and strict critical structure constraint is a challenge for modern radiation planning and delivery systems. Several advanced radiation treatment techniques can be used for fractionated stereotactic ablative radiosurgery (FSRS) in select patients with unresectable recurrent head and neck tumors. The purpose of this study is to compare treatment plans of the CyberKnife stereotactic radiosurgery (CK), intensity modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) to better understand the dosimetry advantage of each technique. Eighteen FSRS patients treated at our institution were involved in this study. Prescription doses were 21-27 Gy in 3 fractions (n=9) and 45 Gy in 5 fractions (n=9). For each patient, planning target and organ at risk (OAR) volumes were imported into 3 separate treatment planning systems (TPS) through a DICOM-RT protocol, and treatment plans were generated using the Accuray Precision (CK plan), Varian Eclipse (IMPT plan) and Philips Pinnacle (VMAT plan on Truebeam STx) TPS, respectively. Planning goals were to achieve the best target coverage of prescribed dose without compromising the critical organs at risk dose volume constraints of the clinical treatment plans. Plans were compared based on target coverage, conformity index, gradient index, dose homogeneity, low dose bath volume (ratio of total volume irradiated between 20% and 50% prescription dose and the target volume), and mean/maximum doses to OARs. The mean planning target volume was 18.2 cm3 (range: 2.1 - 36.4 cm3). The clinical OAR goals were met among all plans for each patient. VMAT and CK plans demonstrated comparable target coverage, and both plans demonstrated better target coverage than IMPT plans (P <0.05). The gradient index was superior for CK plans compared to either IMPT or VMAT plans (P <0.01). Target conformity was the highest among CK plans and lowest among IMPT plans. VMAT plans showed the most uniform dose distribution inside the prescribed target. The low dose bath volume was largest for VMAT (P <0.01) and comparable between CK and IMPT plans. Our overall assessment demonstrated that CK, VMAT and IMPT plans are capable of producing highly conformal and clinical acceptable plans for head and neck FSRS. CK plans provide the best combination of dose conformity and target coverage. VMAT plans were the most uniform but at the expense of less normal tissue sparing. IMPT plans provide a very low dose bath but less favorable target coverage due to >1cm proton scanning spot size." @default.
• W2896877142 created "2018-10-26" @default.
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• W2896877142 date "2018-11-01" @default.
• W2896877142 modified "2023-10-07" @default.
• W2896877142 title "Treatment Planning Comparison of Robotic Radiosurgery, Treatment Delivery System and Proton Treatment for Head and Neck Stereotactic Radiation Therapy Patients" @default.
• W2896877142 doi "https://doi.org/10.1016/j.ijrobp.2018.07.1469" @default.
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