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新型环装 Halcyon 医用直线加速器行双椎体分段立体定向放疗:计划质量、治疗效率与精度。

Double-vertebral segment SBRT via novel ring-mounted Halcyon Linac: Plan quality, delivery efficiency and accuracy.

机构信息

University of Kentucky, Department of Radiation Medicine, Lexington, KY, USA.

University of Kentucky, Department of Radiation Medicine, Lexington, KY, USA.

出版信息

Med Dosim. 2022;47(1):20-25. doi: 10.1016/j.meddos.2021.07.001. Epub 2021 Aug 16.

Abstract

To evaluate the plan quality, treatment delivery efficiency, and accuracy of single-isocenter/multi-target (SIMT) volumetric modulated arc therapy (VMAT) of double-vertebral segments stereotactic body radiation therapy (SBRT) on Halcyon ring delivery system (RDS). In-house multi-target end-to-end phantom testing and independent dose verification using the MD Anderson's single-isocenter/multi-target (lung/spine targets) thorax phantom were completed. Six previously treated patients with 2-vertebral segments on thoracic and/or lumber spine were replanned on Halcyon RDS with 6MV-FFF beam using a single-isocenter placed between the vertebral segments. Three full VMAT arcs with 0° and ±10° collimator angles and advanced Acuros-based dose engine for heterogeneity corrections were used. Prescription was 35 Gy in 5 fractions to each vertebral-segment, simultaneously. For comparison, Halcyon VMAT-SBRT plans were retrospectively created on SBRT-dedicated Truebeam with a 6MV-FFF beam using identical planning geometry and optimization objectives. Target coverage, conformity index (CI), heterogeneity index (HI), gradient index (GI), dose to 2-cm away from each target (D2-cm), and dose to adjacent organs-at-risk (OAR) were evaluated per NRG-BR002 protocol. Treatment delivery parameters were evaluated for both plans. In-house phantom measurements showed acceptable spatial accuracy (< 1mm within 5-cm from the isocenter) of conebeam CT-guided Halcyon SBRT treatments. The MD Anderson phantom irradiation credentialing results met IROC requirements for protocol patients. Mean isocenter-to-tumor center distance was 3.3 ± 0.6-cm (range 2.4 to 4.3-cm). Mean combined PTV was 57.3 ± 31.3 cc (range 20.1 to 99.9 cc). Both Halcyon and Truebeam SIMT-VMAT plans met NRG-BR002 compliance criteria and show similar CI, HI, GI, D2-cm. Maximal and volumetric doses to adjacent OAR including dose to partial spinal cord were lower with Halcyon RDS. Average total monitor units, modulation, and overall treatment time were lower with Halcyon plans by 130 MU, 0.2, 3.8 min, respectively, with similar beam-on time. Average pre-treatment patient-specific portal-dosimetry QA results on Halcyon showed a high pass rate of 99.6%, compared to SBRT-dedicated Truebeam pass rate of 96.8%, for 2%/2 mm clinical gamma passing criteria, suggesting more accurate treatment delivery on Halcyon RDS. SBRT treatment of double-vertebral segments via SIMT-VMAT plans on Halcyon for selected patients is feasible and dosimetrically superior to Truebeam Linac. Faster treatment delivery (<10 min) of double-vertebral segment SBRT on Halcyon could reduce patient intolerance due to severe back pain, potentially reduce intra-fraction motion errors, and improve patient throughput, and clinic workflow.

摘要

评估 Halcyon 环式调强放射治疗(RDS)系统上双椎体段立体定向体部放射治疗(SBRT)的单等中心/多靶区(SIMT)容积调强弧形治疗(VMAT)计划质量、治疗交付效率和准确性。在室内使用多靶端到端体模进行了多靶区测试,并使用 MD Anderson 的单等中心/多靶区(肺/脊柱靶区)胸部体模进行了独立剂量验证。对 6 名之前接受过治疗的患者进行了重新计划,他们的胸段和/或腰段有 2 个椎体段,在 Halcyon RDS 上使用放置在椎体段之间的单个等中心位置,采用 6MV-FFF 射线进行治疗。使用 3 个全 VMAT 弧形,带有 0°和±10°准直器角度,并使用基于 Acuros 的先进剂量引擎进行不均匀性校正。处方剂量为每个椎体段 35 Gy,分 5 次给予。为了进行比较,在 SBRT 专用 Truebeam 上使用相同的计划几何形状和优化目标,回顾性地创建了 Halcyon VMAT-SBRT 计划。根据 NRG-BR002 协议评估了每个靶区的覆盖率、适形指数(CI)、不均匀性指数(HI)、梯度指数(GI)、靶区 2cm 处的剂量(D2-cm)和相邻危及器官(OAR)的剂量。评估了两种计划的治疗交付参数。室内体模测量结果表明,锥形束 CT 引导的 Halcyon SBRT 治疗的空间精度可接受(距等中心 5cm 内<1mm)。MD Anderson 体模照射认证结果符合 IROC 对协议患者的要求。平均等中心到肿瘤中心的距离为 3.3±0.6cm(范围 2.4 至 4.3cm)。平均联合 PTV 为 57.3±31.3cc(范围 20.1 至 99.9cc)。Halcyon 和 Truebeam 的 SIMT-VMAT 计划均符合 NRG-BR002 合规标准,且 CI、HI、GI、D2-cm 相似。包括部分脊髓剂量在内的相邻 OAR 的最大和体积剂量在 Halcyon RDS 上较低。Halcyon 计划的平均总监测单位、调制和总治疗时间分别降低了 130MU、0.2 和 3.8 分钟,而光束开启时间相似。Halcyon 上的患者特定术前门户剂量学 QA 结果的平均预治疗结果显示,与 SBRT 专用 Truebeam 的 96.8%通过率相比,2%/2mm 临床伽马通过率为 99.6%,这表明 Halcyon RDS 的治疗交付更准确。对于选定的患者,通过 Halcyon 上的 SIMT-VMAT 计划对双椎体段进行 SBRT 是可行的,并且在剂量学上优于 Truebeam 直线加速器。Halcyon 上双椎体段 SBRT 的更快治疗交付(<10 分钟)可能会减少因严重背痛引起的患者不耐受,潜在地减少分次内运动误差,并提高患者吞吐量和临床工作流程。

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