Knutson Nels C, Kennedy William R, Reynoso Francisco J, Peng Jiayuan, Henke Lauren E, Laugeman Eric, Watts Michael, Hillard Jessica, Heermann Ana, Hugo Geoffrey D, Mutic Sasa, Cai Bin
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
Adv Radiat Oncol. 2020 Jan 28;5(3):482-489. doi: 10.1016/j.adro.2020.01.003. eCollection 2020 May-Jun.
To test the feasibility of a simplified, robust, workflow for intracranial stereotactic radiation therapy (SRT) using a ring gantry linear accelerator (RGLA) equipped with a dual-layer stacked, staggered, and interdigitating multileaf collimator.
Twenty recent clinical SRT cases treated using a radiosurgery c-arm linear accelerator were anonymized. From these data sets, a new planning workflow was developed and used to replan these cases, which then were compared to their clinical counterparts. Population-based dose-volume histograms were analyzed for target coverage and sparing of healthy brain. All plans underwent plan review and quality assurance and were delivered on an end-to-end verification phantom using image guidance to simulate treatment.
The RGLA plans were able to meet departmental standards for target coverage and organ-at-risk sparing and showed plan quality similar to the clinical plans. RGLA plans showed increases in the 50% isodose in the axial plane but decreases in the sagittal and coronal planes. There were no statistically significant differences in the homogeneity index or number of monitor units between the 2 systems. There were statistically significant increases in conformity and gradient indices, with median values of 1.09 versus 1.11 and 2.82 versus 3.13, respectively, for the c-arm versus RGLA plans. These differences were not believed to be clinically significant because they met clinical goals. The population-based dose-volume histograms showed target coverage and organ-at-risk sparing similar to that of the clinical plans. All plans were able to meet the departmental quality assurance requirements and were delivered under image guidance on an end-to-end phantom with measurements agreeing within 3% of the expected value. RGLA plans showed a median reduction in delivery time of ≈50%.
This work describes a simplified and efficient workflow that could reduce treatment times and expand access to SRT to centers using an RGLA.
使用配备双层堆叠、交错和相互交错多叶准直器的环形机架直线加速器（RGLA），测试一种简化、稳健的颅内立体定向放射治疗（SRT）工作流程的可行性。
对20例近期使用放射外科C形臂直线加速器治疗的临床SRT病例进行匿名处理。从这些数据集中，开发了一种新的计划工作流程并用于重新规划这些病例，然后将其与临床对应病例进行比较。分析基于人群的剂量体积直方图，以评估靶区覆盖情况和对健康脑组织的保护。所有计划均经过计划审查和质量保证，并在使用图像引导的端到端验证体模上进行模拟治疗。
RGLA计划能够满足靶区覆盖和危及器官保护的部门标准，并且显示出与临床计划相似的计划质量。RGLA计划在轴向平面上50%等剂量线增加，但在矢状面和冠状面上减少。两个系统之间的均匀性指数或监测单位数量没有统计学显著差异。适形指数和梯度指数有统计学显著增加，C形臂计划与RGLA计划的中位数分别为1.09对1.11和2.82对3.13。这些差异被认为在临床上不显著，因为它们达到了临床目标。基于人群的剂量体积直方图显示靶区覆盖和危及器官保护与临床计划相似。所有计划都能够满足部门质量保证要求，并在图像引导下在端到端体模上进行交付，测量结果与预期值的偏差在3%以内。RGLA计划显示交付时间中位数减少约50%。
本研究描述了一种简化且高效能的工作流程，该流程可以减少治疗时间，并将SRT的可及性扩展到使用RGLA的中心。
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