Alison Starke1, Jonathan Bowden2, Rebecca Lynn3, Keith Hall1, Kate Hudson1, Ana Rato1, Emma Aldridge1, Dean Robb1, Paula Steele1, Jessica Brady3, Nabegh George Mikhaeel4. 1. The London Radiotherapy Centre, Part of HCA Healthcare UK, London, UK. 2. The London Radiotherapy Centre, Part of HCA Healthcare UK, London, UK. Electronic address: Jonathan.bowden@hcahealthcare.co.uk. 3. Guy's Cancer Centre, Guy's & St Thomas' NHS Trust, London, UK. 4. The London Radiotherapy Centre, Part of HCA Healthcare UK, London, UK; Guy's Cancer Centre, Guy's & St Thomas' NHS Trust, London, UK; Cancer Division, Faculty of Life Sciences and Medicine, King's College London University, UK.
Abstract
PURPOSE: Radiotherapy is an effective treatment for mediastinal lymphoma but induces late effects including cardiac toxicity and secondary breast and lung cancer. Therefore reducing the dose to these organs is vital. We compared full arc volumetric modulated arc therapy (F-VMAT) against limited angle 'Butterfly' VMAT (B-VMAT) on free breathing (FB) and deep inspiration breath-hold (DIBH) computed tomography scans. The aim was to assess the benefits of B-VMAT over F-VMAT and to establish if the addition of DIBH results is a cumulative benefit. MATERIALS AND METHODS: F-VMAT and B-VMAT plans were calculated for 20 consecutive patients (15 females) with mediastinal lymphoma on both FB and DIBH scans. The planning target volume V95% was kept comparable between all plans while reducing organ doses as much as possible. RESULTS: B-VMAT significantly reduced low lung doses (V5-10), while F-VMAT was better for higher lung doses (V20-30). DIBH further improved lung doses for both types of plans. DIBH B-VMAT produced the lowest mean lung dose. With FB, heart doses were slightly higher for B-VMAT but the maximum difference was small (0.8% for V20) and only statistically significant for V10-20. The mean heart dose increased by only 0.1 Gy. The addition of DIBH however significantly reduced heart doses. While DIBH F-VMAT had the lowest heart doses, the difference was small compared with DIBH B-VMAT. B-VMAT significantly reduced breast V4 while DIBH reduced the V10. CONCLUSION: B-VMAT and DIBH are both effective in reducing organ doses and the dosimetric benefit is additive for some parameters and complementary for others.
PURPOSE: Radiotherapy is an effective treatment for mediastinal lymphoma but induces late effects including cardiac toxicity and secondary breast and lung cancer. Therefore reducing the dose to these organs is vital. We compared full arc volumetric modulated arc therapy (F-VMAT) against limited angle 'Butterfly' VMAT (B-VMAT) on free breathing (FB) and deep inspiration breath-hold (DIBH) computed tomography scans. The aim was to assess the benefits of B-VMAT over F-VMAT and to establish if the addition of DIBH results is a cumulative benefit. MATERIALS AND METHODS: F-VMAT and B-VMAT plans were calculated for 20 consecutive patients (15 females) with mediastinal lymphoma on both FB and DIBH scans. The planning target volume V95% was kept comparable between all plans while reducing organ doses as much as possible. RESULTS: B-VMAT significantly reduced low lung doses (V5-10), while F-VMAT was better for higher lung doses (V20-30). DIBH further improved lung doses for both types of plans. DIBH B-VMAT produced the lowest mean lung dose. With FB, heart doses were slightly higher for B-VMAT but the maximum difference was small (0.8% for V20) and only statistically significant for V10-20. The mean heart dose increased by only 0.1 Gy. The addition of DIBH however significantly reduced heart doses. While DIBH F-VMAT had the lowest heart doses, the difference was small compared with DIBH B-VMAT. B-VMAT significantly reduced breast V4 while DIBH reduced the V10. CONCLUSION: B-VMAT and DIBH are both effective in reducing organ doses and the dosimetric benefit is additive for some parameters and complementary for others.
Authors: Katie S Jones; Amanda Webster; Georgios Ntentas; Jessica L Brady; N George Mikhaeel Journal: Tech Innov Patient Support Radiat Oncol Date: 2022-04-09
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Authors: Katie S Jones; Amanda Webster; Georgios Ntentas; Jessica L Brady; N George Mikhaeel Journal: Tech Innov Patient Support Radiat Oncol Date: 2022-04-09
Authors: Chelsea C Pinnix; Jillian R Gunther; Penny Fang; Mikaela E Bankston; Sarah A Milgrom; David Boyce; Hun Ju Lee; Ranjit Nair; Raphael Steiner; Paolo Strati; Sairah Ahmed; Swaminathan P Iyer; Jason Westin; Simrit Parmar; M Alma Rodriguez; Loretta Nastoupil; Sattva Neelapu; Christopher Flowers; Bouthaina S Dabaja Journal: JAMA Netw Open Date: 2020-09-01