Simultaneous integrated protection : A new concept for high-precision radiation therapy.
Τίτλος | Simultaneous integrated protection : A new concept for high-precision radiation therapy. |
Publication Type | Journal Article |
Year of Publication | 2016 |
Authors | Brunner, T. B., Nestle U., Adebahr S., Gkika E., Wiehle R., Baltas D., & Grosu A-L. |
Journal | Strahlenther Onkol |
Volume | 192 |
Issue | 12 |
Pagination | 886-894 |
Date Published | 2016 Dec |
ISSN | 1439-099X |
Λέξεις κλειδιά | Dose Hypofractionation, Dose-Response Relationship, Radiation, Humans, Neoplasms, Organ Sparing Treatments, Organs at Risk, Radiation Injuries, Radiation Protection, Radiosurgery, Radiotherapy Planning, Computer-Assisted, Reproducibility of Results, Sensitivity and Specificity, Treatment Outcome |
Abstract | OBJECTIVE: Stereotactic radiotherapy near serial organs at risk (OAR) requires special caution. A novel intensity-modulated radiotherapy (IMRT) prescription concept termed simultaneous integrated protection (SIP) for quantifiable and comparable dose prescription to targets very close to OAR is described.MATERIALS AND METHODS: An intersection volume of a planning risk volume (PRV) with the total planning target volume (PTV) defined the protection volume (PTV). The remainder of the PTV represented the dominant PTV (PTV). Planning was performed using IMRT. Dose was prescribed to PTV according to ICRU in 3, 5, 8, or 12 fractions. Constraints to OARs were expressed as absolute and as equieffective doses at 2 Gy (EQD2). Dose to the gross risk volume of an OAR was to respect constraints. Violation of constraints to OAR triggered a planning iteration at increased fractionation. Dose to PTV was required to be as high as possible within the constraints to avoid local relapse.RESULTS: SIP was applied in 6 patients with OAR being large airways (n = 2) or bowel (n = 4) in 3, 5, 8, and 12 fractions in 1, 3, 1, and 1 patients, respectively. PTVs were 14.5-84.9 ml and PTV 1.8-3.9 ml (2.9-13.4 % of PTV). Safety of the plans was analyzed from the absolute dose-volume histogram (dose to ml). The steepness of dose fall-off could be determined by comparing the dose constraints to the PRVs with those to the OARs (Wilcoxon test p = 0.001). Constraints were respected for the corresponding OARs. All patients had local control at a median 9 month follow-up and toxicity was low.CONCLUSION: SIP results in a median dose of ≥100 % to PTV, to achieve high local control and low toxicity. Longer follow-up is required to verify results and a prospective clinical trial is currently testing this new approach in chest and abdomen stereotactic body radiotherapy. |
DOI | 10.1007/s00066-016-1057-x |
Alternate Journal | Strahlenther Onkol |
PubMed ID | 27757502 |
PubMed Central ID | PMC5122615 |