AbstractObjective To investigate the implementation procedures and dosimetric verification of the first patient treated with total body irradiation (TBI) based on volumetric modulated arc therapy (VMAT). Methods Two sets of CT images were acquired under the head-in first and foot-in first to contour the planning target volume (PTV) of the cranial and caudal segments to accomplish the treatment of the whole body length, on which two interrelated plans of 5 subsequent isocenters with a total of 15 VMAT fields were performed to cover all PTVs. The plans were prescribed to ensure 90% PTV dose coverage with a total dose of 12Gy in 6 fractions. Firstly, a dose optimization was performed on the caudal CT images, then the cranial CT images were optimized based on the dose distribution of the caudal CT images. The evaluation of the final treatment plan was carried out based on a plan sum of both two sets of images. The parameters of PTV and organs at risk (OARs) were measured by dose volume histograms from the accumulated plan. The quality assurance comprised the verification of the VMAT plans for each individual isocenter via Delta4 phantom. The dose distribution in the overlapped region between two adjacent central fields was verified with EBT3 film. The absolute dose at the overlapped region between two images was measured via Pinpoint chamber. In vivo dosimetry on the patient′s skin was monitored by MOSFET dosimeters. The results of planning parameters and treatment duration were analyzed. Results The mean doses of two segments of PTVs were 12.45Gy and 12.37Gy. The mean dose for the lung was 10.8Gy. The machine unit (MU) and mean treatment delivery time were 2883 MU and 24.3min, and the mean total time per fraction was 121min. The mean 3%/3mmγ-analysis pass rate for each isocenter VMAT plan was (99.74±0.42)%, and the mean 5%/5mmγ-analysis pass rate for the overlapped region was (90.11±2.72)%. The average deviation of absolute dose in the overlap region of the caudal and cranial images was (3.6±0.4)%.In vivo measurement of 8 points on the patient showed that the dose of each region was ranged from 1.57Gy to 2.04Gy. Conclusion According to the results of dosimetric verification, TBI based on multi-isocenter VMAT can be applied in clinical practice, which remains to be improved in terms of dose distribution, measurement results and clinical efficiency.
Jiang Xiaoqin,Su Baofeng,Chen Chunxiang et al. First clinical application and dosimetric verification of total body irradiation with volumetric modulated arc therapy[J]. Chinese Journal of Radiation Oncology, 2021, 30(8): 828-834.
Jiang Xiaoqin,Su Baofeng,Chen Chunxiang et al. First clinical application and dosimetric verification of total body irradiation with volumetric modulated arc therapy[J]. Chinese Journal of Radiation Oncology, 2021, 30(8): 828-834.
[1] Burnett A, Wetzler M, Löwenberg B. Therapeutic advances in acute myeloid leukemia[J]. J Clin Oncol, 2011, 29(5):487-494. DOI:10.1200/JCO.2010.30.1820. [2] Ringdén O, Labopin M, Tura S, et al. A comparison of busulphan versus total body irradiation combined with cyclophosphamide as conditioning for autograft or allograft bone marrow transplantation in patients with acute leukaemia. acute leukaemia working party of the European group for blood and marrow transplantation (EBMT)[J]. Br J Haematol, 1996, 93(3):637-645. DOI:10.1046/j.1365-2141.1996.d01-1681.x. [3] Davies SM, Ramsay NK, Klein JP, et al. Comparison of preparative regimens in transplants for children with acute lymphoblastic leukemia[J]. J Clin Oncol, 2000, 18(2):340-347. DOI:10.1200/JCO.2000.18.2.340. [4] Hui SK, Kapatoes J, Fowler J, et al. Feasibility study of helical tomotherapy for total body or total marrow irradiation[J]. Med Phys, 2005, 32(10):3214-3224. DOI:10.1118/1.2044428. [5] Wong JY, Liu A, Schultheiss T, et al. Targeted total marrow irradiation using three-dimensional image-guided tomographic intensity-modulated radiation therapy:an alternative to standard total body irradiation[J]. Biol Blood Marrow Transplant, 2006, 12(3):306-315. DOI:10.1016/j.bbmt.2005.10.026. [6] Han C, Schultheisss TE, Wong JY. Dosimetric study of volumetric modulated arc therapy fields for total marrow irradiation[J]. Radiother Oncol, 2012, 102(2):315-320. DOI:10.1016/j.radonc.2011.06.005. [7] Gruen A, Ebell W, Wlodarczyk W, et al. Total body irradiation (TBI) using helical Tomotherapy in children and young adults undergoing stem cell transplantation[J]. Radiat Oncol, 2013, 8:92. DOI:10.1186/1748-717X-8-92. [8] Guo R, Tang LL, Mao YP, et al. Clinical outcomes of volume-modulated arc therapy in 205 patients with nasopharyngeal carcinoma:an analysis of survival and treatment toxicities[J/OL]. PLoS One, 2015, 10(7):e0129679. DOI:10.1371/journal.pone.0129679. [9] Takahashi W, Yamashita H, Kida S, et al. Verification of planning target volume settings in volumetric modulated arc therapy for stereotactic body radiation therapy by using in-treatment 4-dimensional cone beam computed tomography[J]. Int J Radiat Oncol Biol Phys, 2013, 86(3):426-431. DOI:10.1016/j.ijrobp.2013.02.019. [10] Chakraborty S, Cheruliyil S, Bharthan RK. Total body irradiation using VMAT (RapidArc):a planning study of a novel treatment delivery method[J]. Int J Cancer Ther Oncol, 2015, 3(2):1-7. DOI:10.14319/ijcto.0302.8. [11] Symons K, Morrison C, Parry J, et al. Volumetric modulated arc therapy for total body irradiation:a feasibility study using Pinnacle (3) treatment planning system and Elekta AgilityTM linac[J]. J Appl Clin Med Phys, 2018, 19(2):103-110. DOI:10.1002/acm2.12257. [12] 王凯,崔懋彦,罗迪,等. 容积调强弧形治疗技术在全身放疗中运用的可行性研究[J]. 临床肿瘤学杂志,2017, 22(6):544-547. Wang K,Cui MY,Luo D, et al. Feasibility study of volume modulated arc therapy for total body irradiation[J]. Chin Clin Oncol, 2017, 22(6):544-547. [13] Springer A, Hammer J, Winkler E, et al. Total body irradiation with volumetric modulated arc therapy:dosimetric data and first clinical experience[J]. Radiat Oncol, 2016, 11:46. DOI:10.1186/s13014-016-0625-7. [14] Strojnik A, Méndez I, Peterlin P. Reducing the dosimetric impact of positional errors in field junctions for craniospinal irradiation using VMAT[J]. Rep Pract Oncol Radiother, 2016, 21(3):232-239. DOI:10.1016/j.rpor.2016.03.002. [15] Wong J, Filippi AR, Dabaja BS, et al. Total body irradiation:guidelines from the international lymphoma radiation oncology group (ILROG)[J]. Int J Radiat Oncol Biol Phys, 2018, 101(3):521-529. DOI:10.1016/j.ijrobp.2018.04.071. [16] Tas B, Durmus IF, Okumus A, et al. Total-body irradiation using linac-based volumetric modulated arc therapy:its clinical accuracy, feasibility and reliability[J]. Radiother Oncol, 2018, 129(3):527-533. DOI:10.1016/j.radonc.2018.08.005. [17] Studinski R, Fraser DJ, Samant RS, et al. Current practice in total-body irradiation:results of a Canada-wide survey[J]. Curr Oncol, 2017, 24(3):181-186. DOI:10.3747/co.24.3484. [18] Wilkie JR, Tiryaki H, Smith BD, et al. Feasibility study for linac-based intensity modulated total marrow irradiation[J]. Med Phys, 2008, 35(12):5609-5618. DOI:10.1118/1.2990779. [19] Jiang B, Dai J, Zhang Y, et al. Feasibility study of a novel rotational and translational method for linac-based intensity modulated total marrow irradiation[J]. Technol Cancer Res Treat, 2012, 11(3):237-247. DOI:10.7785/tcrt.2012.500292. [20] Van DJ, Galvin JM, Glasgow GP, et al. The physical aspects of total and half body photon irradiation[R]. Maryland:AAPM Report No.17, 1986.