Kovalchuk Nataliya, Simiele Eric, Skinner Lawrie, Yang Yong, Howell Nicole, Lewis Jonathan, Hui Caressa, Blomain Erik, Hoppe Richard T, Hiniker Susan M
Department of Radiation Oncology, Stanford University, Stanford, California.
Department of Radiation Oncology, Stanford University, Stanford, California.
Pract Radiat Oncol. 2022 May-Jun;12(3):245-258. doi: 10.1016/j.prro.2021.12.007. Epub 2022 Feb 17.
In this article, we describe the technical aspects of the Stanford volumetric modulated arc therapy (VMAT) total body irradiation (TBI) technique, compare it with other VMAT-TBI techniques, and share our initial experience.
From September 2019 to August 2021, 35 patients were treated with VMAT-TBI at our institution. Treatment planning was performed using in-house developed automated planning scripts. Organ sparing depended on the regimen: myeloablative (lungs, kidneys, and lenses) and nonmyeloablative with benign disease (lungs, kidneys, lenses, gonads, brain, and thyroid). Quality assurance was performed using electronic portal imaging device portal dosimetry and Mobius3D. Robustness was evaluated for the first 10 patients by performing local and global isocenter shifts of 5 mm. Treatment was delivered using image-guided radiation therapy for every isocenter and every fraction. In vivo measurements were performed on the match line between the VMAT and anterior-posterior/posterior-anterior fields and on the testes for the first fraction.
The lungs, lungs - 1 cm, and kidneys D were consistently spared to 57.6% ± 4.4%, 40.7% ± 5.5%, and 70.0% ± 9.9% of the prescription dose, respectively. Gonadal sparing (D = 0.69 ± 0.13 Gy) was performed for all patients with benign disease. The average planning target volume (PTV) maximum dose to 1 cubic centimeter (D) was 120.7% ± 6.4% for all patients. The average Gamma passing rate for the VMAT plans was 98.1% ± 1.6% (criterion of 3%/2 mm). Minimal differences were observed between Mobius3D- and Eclipse AAA-calculated PTV D (0.0% ± 0.3%) and lungs D (-2.5% ± 1.2%). Robustness evaluation showed that the PTV D and lungs D were insensitive to small positioning deviations between the VMAT isocenters (1.1% ± 2.4% and 1.2% ± 1.0%, respectively). The average match-line dose measurement indicated patient setup was reproducible (96.1% ± 4.5% relative to prescription dose). Treatment time, including patient setup and beam-on, was 47.5 ± 9.5 min.
The Stanford VMAT-TBI technique, from simulation to treatment delivery, was presented and compared with other VMAT-TBI techniques. Together with publicly shared autoplanning scripts, our technique may provide the gateway for wider adaptation of this technology and the possibility of multi-institutional studies in the cooperative group setting.
在本文中，我们描述了斯坦福容积调强弧形放疗（VMAT）全身照射（TBI）技术的技术层面，将其与其他VMAT-TBI技术进行比较，并分享我们的初步经验。
2019年9月至2021年8月，我们机构对35例患者进行了VMAT-TBI治疗。使用内部开发的自动计划脚本进行治疗计划。器官保护取决于治疗方案：清髓性（肺、肾和晶状体）以及良性疾病的非清髓性（肺、肾、晶状体、性腺、脑和甲状腺）。使用电子射野影像装置射野剂量测定法和Mobius3D进行质量保证。通过对前10例患者进行5毫米的局部和整体等中心移位来评估稳健性。对每个等中心和每个分次使用图像引导放射治疗进行治疗。对VMAT与前后/后前野之间的匹配线以及第一个分次的睾丸进行体内测量。
肺、肺-1厘米处和肾的D平均分别被保护在处方剂量的57.6%±4.4%、40.7%±5.5%和70.0%±9.9%。对所有患有良性疾病的患者进行了性腺保护（D=0.69±0.13 Gy）。所有患者的计划靶区（PTV）1立方厘米的平均最大剂量（D）为120.7%±6.4%。VMAT计划的平均伽马通过率为98.1%±1.6%（标准为3%/2毫米）。在Mobius3D和Eclipse AAA计算的PTV D（0.0%±0.3%）和肺D（-2.5%±1.2%）之间观察到极小的差异。稳健性评估表明，PTV D和肺D对VMAT等中心之间的小定位偏差不敏感（分别为1.1%±2.4%和1.2%±1.0%）。平均匹配线剂量测量表明患者摆位具有可重复性（相对于处方剂量为96.1%±4.5%）。治疗时间，包括患者摆位和射束开启时间，为47.5±9.5分钟。
介绍了斯坦福VMAT-TBI技术，从模拟到治疗实施，并与其他VMAT-TBI技术进行了比较。连同公开共享的自动计划脚本，我们的技术可能为该技术更广泛的应用以及在合作组环境中进行多机构研究提供途径。
