Christos Moustakis1,2, Oliver Blanck3,4, Fatemeh Ebrahimi Tazehmahalleh5,6, Mark Ka Heng Chan3, Iris Ernst5,7, Thomas Krieger8, Marciana-Nona Duma9, Markus Oechsner9, Ute Ganswindt10, Christian Heinz10, Horst Alheit11, Hilbert Blank11, Ursula Nestle12, Rolf Wiehle12, Christine Kornhuber13, Christian Ostheimer13, Cordula Petersen14, Gerhard Pollul15, Wolfgang Baus16, Georg Altenstein16, Eric Beckers17, Katrin Jurianz17, Florian Sterzing18, Matthias Kretschmer19, Heinrich Seegenschmiedt20, Torsten Maass20, Stefan Droege21, Ulrich Wolf22, Juergen Schoeffler23, Uwe Haverkamp5,7, Hans Theodor Eich5,7, Matthias Guckenberger24. 1. Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. christos.moustakis@ukmuenster.de. 2. German CyberKnife Center, Soest, Germany. christos.moustakis@ukmuenster.de. 3. Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig Holstein, Kiel, Germany. 4. Güstrow and Frankfurt, Saphir Radiosurgery Center, Frankfurt, Germany. 5. Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. 6. City Hospital Dessau, Dessau, Germany. 7. German CyberKnife Center, Soest, Germany. 8. Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany. 9. Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 10. Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany. 11. Radiationtherapy Distler, Bautzen, Germany. 12. Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany. 13. Department of Radiation Oncology, University Halle, Halle, Germany. 14. University Hospital Hamburg-Eppendorf, Hamburg, Germany. 15. Department of Radiation Oncology, University Mainz, Mainz, Germany. 16. University Hospital of Cologne, Cologne, Germany. 17. Gamma Knife Center Krefeld, Krefeld, Germany. 18. University Hospital Heidelberg, Heidelberg, Germany. 19. Radiologische Allianz Hamburg, Hamburg, Germany. 20. Radiationtherapy and Cyberknife Center Hamburg, Hamburg, Germany. 21. Lung Clinic Hemer, Hemer, Germany. 22. Department of Radiation Oncology, University Leipzig, Leipzig, Germany. 23. Radiationtherapy Department Boeblingen, Boeblingen, Germany. 24. Department of Radiation Oncology, University Zurich, Zurich, Switzerland.
Abstract
PURPOSE: The aim was to evaluate stereotactic body radiation therapy (SBRT) treatment planning variability for early stage nonsmall cell lung cancer (NSCLC) with respect to the published guidelines of the Stereotactic Radiotherapy Working Group of the German Society for Radiation Oncology (DEGRO). MATERIALS AND METHODS: Planning computed tomography (CT) scan and the structure sets (planning target volume, PTV; organs at risk, OARs) of 3 patients with early stage NSCLC were sent to 22 radiotherapy departments with SBRT experience: each department was asked to prepare a treatment plan according to the DEGRO guidelines. The prescription dose was 3 fractions of 15 Gy to the 65% isodose. RESULTS: In all, 87 plans were generated: 36 used intensity-modulated arc therapy (IMAT), 21 used three-dimensional conformal radiation therapy (3DCRT), 6 used static field intensity-modulated radiation therapy (SF-IMRT), 9 used helical radiotherapy and 15 used robotic radiosurgery. PTV dose coverage and simultaneously kept OARs doses were within the clinical limits published in the DEGRO guidelines. However, mean PTV dose (mean 58.0 Gy, range 52.8-66.4 Gy) and dose conformity indices (mean 0.75, range 0.60-1.00) varied between institutions and techniques (p ≤ 0.02). OARs doses varied substantially between institutions, but appeared to be technique independent (p = 0.21). CONCLUSION: All studied treatment techniques are well suited for SBRT of early stage NSCLC according to the DEGRO guidelines. Homogenization of SBRT practice in Germany is possible through the guidelines; however, detailed treatment plan characteristics varied between techniques and institutions and further homogenization is warranted in future studies and recommendations. Optimized treatment planning should always follow the ALARA (as low as reasonably achievable) principle.
PURPOSE: The aim was to evaluate stereotactic body radiation therapy (SBRT) treatment planning variability for early stage nonsmall cell lung cancer (NSCLC) with respect to the published guidelines of the Stereotactic Radiotherapy Working Group of the German Society for Radiation Oncology (DEGRO). MATERIALS AND METHODS: Planning computed tomography (CT) scan and the structure sets (planning target volume, PTV; organs at risk, OARs) of 3 patients with early stage NSCLC were sent to 22 radiotherapy departments with SBRT experience: each department was asked to prepare a treatment plan according to the DEGRO guidelines. The prescription dose was 3 fractions of 15 Gy to the 65% isodose. RESULTS: In all, 87 plans were generated: 36 used intensity-modulated arc therapy (IMAT), 21 used three-dimensional conformal radiation therapy (3DCRT), 6 used static field intensity-modulated radiation therapy (SF-IMRT), 9 used helical radiotherapy and 15 used robotic radiosurgery. PTV dose coverage and simultaneously kept OARs doses were within the clinical limits published in the DEGRO guidelines. However, mean PTV dose (mean 58.0 Gy, range 52.8-66.4 Gy) and dose conformity indices (mean 0.75, range 0.60-1.00) varied between institutions and techniques (p ≤ 0.02). OARs doses varied substantially between institutions, but appeared to be technique independent (p = 0.21). CONCLUSION: All studied treatment techniques are well suited for SBRT of early stage NSCLC according to the DEGRO guidelines. Homogenization of SBRT practice in Germany is possible through the guidelines; however, detailed treatment plan characteristics varied between techniques and institutions and further homogenization is warranted in future studies and recommendations. Optimized treatment planning should always follow the ALARA (as low as reasonably achievable) principle.
Authors: Francesca Romana Giglioli; Lidia Strigari; Riccardo Ragona; Giuseppina R Borzì; Elisabetta Cagni; Claudia Carbonini; Stefania Clemente; Rita Consorti; Randa El Gawhary; Marco Esposito; Maria Daniela Falco; David Fedele; Christian Fiandra; Maria Cristina Frassanito; Valeria Landoni; Gianfranco Loi; Elena Lorenzini; Maria Rosa Malisan; Carmelo Marino; Enrico Menghi; Barbara Nardiello; Roberta Nigro; Caterina Oliviero; Gabriella Pastore; Mariagrazia Quattrocchi; Ruggero Ruggieri; Irene Redaelli; Giacomo Reggiori; Serenella Russo; Elena Villaggi; Marta Casati; Pietro Mancosu Journal: Phys Med Date: 2016-04-06 Impact factor: 2.685
Authors: Joe Y Chang; Suresh Senan; Marinus A Paul; Reza J Mehran; Alexander V Louie; Peter Balter; Harry J M Groen; Stephen E McRae; Joachim Widder; Lei Feng; Ben E E M van den Borne; Mark F Munsell; Coen Hurkmans; Donald A Berry; Erik van Werkhoven; John J Kresl; Anne-Marie Dingemans; Omar Dawood; Cornelis J A Haasbeek; Larry S Carpenter; Katrien De Jaeger; Ritsuko Komaki; Ben J Slotman; Egbert F Smit; Jack A Roth Journal: Lancet Oncol Date: 2015-05-13 Impact factor: 41.316
Authors: Matthias Guckenberger; Rainer J Klement; Michael Allgäuer; Nicolaus Andratschke; Oliver Blanck; Judit Boda-Heggemann; Karin Dieckmann; Marciana Duma; Iris Ernst; Ute Ganswindt; Peter Hass; Christoph Henkenberens; Richard Holy; Detlef Imhoff; Henning K Kahl; Robert Krempien; Fabian Lohaus; Ursula Nestle; Meinhard Nevinny-Stickel; Cordula Petersen; Sabine Semrau; Jan Streblow; Thomas G Wendt; Andrea Wittig; Michael Flentje; Florian Sterzing Journal: Radiother Oncol Date: 2015-09-15 Impact factor: 6.280
Authors: M Guckenberger; N Andratschke; H Alheit; R Holy; C Moustakis; U Nestle; O Sauer Journal: Strahlenther Onkol Date: 2013-09-21 Impact factor: 3.621
Authors: Mark K H Chan; Dora L W Kwong; Gilbert M L Law; Eric Tam; Anthony Tong; Venus Lee; Sherry C Y Ng Journal: J Appl Clin Med Phys Date: 2013-07-08 Impact factor: 2.102
Authors: Judit Boda-Heggemann; Anika Jahnke; Mark K H Chan; Leila S Ghaderi Ardekani; Peter Hunold; Jost Philipp Schäfer; Stefan Huttenlocher; Stefan Wurster; Dirk Rades; Guido Hildebrandt; Frank Lohr; Jürgen Dunst; Frederik Wenz; Oliver Blanck Journal: Strahlenther Onkol Date: 2018-02-05 Impact factor: 3.621
Authors: Lotte Wilke; Nicolaus Andratschke; Oliver Blanck; Thomas B Brunner; Stephanie E Combs; Anca-Ligia Grosu; Christos Moustakis; Daniela Schmitt; Wolfgang W Baus; Matthias Guckenberger Journal: Strahlenther Onkol Date: 2019-01-16 Impact factor: 3.621
Authors: Christos Moustakis; Oliver Blanck; Fatemeh Ebrahimi; Mark Ka Heng Chan; Iris Ernst; Thomas Krieger; Marciana-Nona Duma; Markus Oechsner; Ute Ganswindt; Christian Heinz; Horst Alheit; Hilbert Blank; Ursula Nestle; Rolf Wiehle; Christine Kornhuber; Christian Ostheimer; Cordula Petersen; Gerhard Pollul; Wolfgang Baus; Georg Altenstein; Eric Beckers; Katrin Jurianz; Florian Sterzing; Matthias Kretschmer; Heinrich Seegenschmiedt; Torsten Maass; Stefan Droege; Ulrich Wolf; Juergen Schoeffler; Uwe Haverkamp; Hans Eich; Matthias Guckenberger Journal: Strahlenther Onkol Date: 2017-09-15 Impact factor: 3.621
Authors: Christos Moustakis; Mark K H Chan; Jinkoo Kim; Joakim Nilsson; Alanah Bergman; Tewfik J Bichay; Isabel Palazon Cano; Savino Cilla; Francesco Deodato; Raffaela Doro; Jürgen Dunst; Hans Theodor Eich; Pierre Fau; Ming Fong; Uwe Haverkamp; Simon Heinze; Guido Hildebrandt; Detlef Imhoff; Erik de Klerck; Janett Köhn; Ulrike Lambrecht; Britta Loutfi-Krauss; Fatemeh Ebrahimi; Laura Masi; Alan H Mayville; Ante Mestrovic; Maaike Milder; Alessio G Morganti; Dirk Rades; Ulla Ramm; Claus Rödel; Frank-Andre Siebert; Wilhelm den Toom; Lei Wang; Stefan Wurster; Achim Schweikard; Scott G Soltys; Samuel Ryu; Oliver Blanck Journal: Strahlenther Onkol Date: 2018-05-25 Impact factor: 3.621
Authors: David Krug; Oliver Blanck; Thomas Demming; Matthias Dottermusch; Karoline Koch; Markus Hirt; Laura Kotzott; Adrian Zaman; Lina Eidinger; Frank-Andre Siebert; Jürgen Dunst; Hendrik Bonnemeier Journal: Strahlenther Onkol Date: 2019-10-31 Impact factor: 3.621