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• W2972748304 abstract "Non-homogeneous dose optimization (NHDO) is exploited in stereotactic body radiotherapy (SBRT) to increase dose delivery to the tumor and allow rapid dose fall-off to surrounding normal tissues. We investigate the changes in plan quality when NHDO is applied to conventionally-fractionated intensity-modulated radiation therapy (CF-IMRT) plans in patients with non-small cell lung cancer (NSCLC) who were not candidates for SBRT. Patients with NSCLC treated with CF-IMRT in 2018 at a single institution were identified. Planning target volumes (PTVs) abutted or overlapped central structures such as the hilum and the heart, but excluded mediastinal nodes or contralateral disease. Prescription doses included 60-66Gy delivered in 1.8-2 Gy per fraction. CF-IMRT treatment plans were re-planned using NHDO principles used in SBRT. NHDO techniques included normalization to lower isodose lines and dose optimization algorithms to force a quick dose fall-off gradient, while maintaining clinically acceptable normal tissue constraints and target coverage. SBRT indices evaluated included: conformity index (CI: ratio of prescription isodose volume to PTV), homogeneity index (HI: PTV (D2%-D98%)/D50%), R50 (ratio of 50% prescribed dose volume to the PTV volume). We compared CF-IMRT to NHDO plans using Wilcoxon signed-rank tests. Median values are reported. Thirteen patients were included. NHDO treatment plans were prescribed to a lower prescription isodose line compared with CF-IMRT plans (85% vs 97%, p=0.001). Percentage of PTV coverage by the prescription dose was similar among CF-IMRT and NHDO plans (97% vs 96%, p=0.3). NHDO plans resulted in a higher mean dose to the PTV compared to CF-IMRT plans (73 Gy vs 67 Gy, p=0.001). Conformity was similar for NHDO and CF-IMRT plans (CI: 1 vs 1.1, p=0.2). NHDO plans were more heterogeneous compared to CF-IMRT plans (HI: 0.31 vs 0.05, p=0.001) and had a steeper dose fall off (R50: 3.5 vs 3.9, p=0.005). All normal tissue dose constraints were met for both plans. NHDO plans resulted in a decreased mean dose to total lungs, esophagus, and heart (relative reduction of -6%, -14%, -15%, respectively, p<0.05). Other normal tissue objectives which improved with NHDO compared to CF-IMRT included: total lung V40 (18% relative reduction, p=0.003) and V60 (17% relative reduction, p=0.004), heart V30 (11% relative reduction, p=0.03), and maximum esophageal dose (11% relative reduction, p=0.02). In select patients, NHDO principles of SBRT can be applied to CF-IMRT resulting in: (1) increased mean tumor dose, (2) reduction in select OAR dose objectives, and (3) maintenance of target coverage and normal tissue constraints. Our data demonstrate that principles of NHDO used in SBRT can also improve plan quality in CF-IMRT. Future studies are needed to evaluate the safety of NHDO plans delivered to NSCLC patients treated with CF-IMRT." @default.
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• W2972748304 date "2019-09-01" @default.
• W2972748304 modified "2023-10-14" @default.
• W2972748304 title "Applying Non-Homogeneous Dose Optimization to Improve Conventionally-fractionated IMRT Plan Quality in Patients with NSCLC" @default.
• W2972748304 doi "https://doi.org/10.1016/j.ijrobp.2019.06.739" @default.
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