Lamberto Widesott1, Francesco Dionisi2, Francesco Fracchiolla2, Francesco Tommasino3, Maurizio Centonze4, Maurizio Amichetti2, Maurizio Del Greco5. 1. Proton Therapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy. Electronic address: lamberto.widesott@apss.tn.it. 2. Proton Therapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy. 3. Department of Physics, University of Trento, Trento, Italy; Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute of Nuclear Physics (INFN), Trento, Italy. 4. Department of Diagnostic Imaging, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy. 5. Department of Cardiac, Santa Maria del Carmine Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Rovereto, Italy.
Abstract
PURPOSE: Ventricular tachycardia (VT) is a life-threatening heart disorder. The aim of this preliminary study is to assess the feasibility of stereotactic body radiation therapy (SBRT) photon and proton therapy (PT) plans for the treatment of VT, adopting robust optimization technique for both irradiation techniques. METHODS: ECG gated CT images (in breath hold) were acquired for one patient. Conventional planning target volume (PTV) and robust optimized plans (25GyE in single fraction) were simulated for both photon (IMRT, 5 and 9 beams) and proton (SFO, 2 beams) plans. Robust optimized plans were obtained both for protons and photons considering in the optimization setup errors (5 mm in the three orthogonal directions), range (±3.5%) and the clinical target volume (CTV) motion due to heartbeat and breath-hold variability. RESULTS: The photon robust optimization method, compared to PTV-based plans, showed a reduction in the average dose to the heart by about 25%; robust optimization allowed also reducing the mean dose to the left lung from 3.4. to 2.8 Gy for 9-beams configuration and from 4.1 to 2.9 Gy for 5-beams configuration. Robust optimization with protons, allowed further reducing the OAR doses: average dose to the heart and to the left lung decreased from 7.3 Gy to 5.2 GyE and from 2.9 Gy to 2.2 GyE, respectively. CONCLUSIONS: Our study demonstrates the importance of the optimization technique adopted in the treatment planning system for VT treatment. It has been shown that robust optimization can significantly reduce the dose to healthy cardiac tissues and that PT further increases this gain.
PURPOSE:Ventricular tachycardia (VT) is a life-threatening heart disorder. The aim of this preliminary study is to assess the feasibility of stereotactic body radiation therapy (SBRT) photon and proton therapy (PT) plans for the treatment of VT, adopting robust optimization technique for both irradiation techniques. METHODS: ECG gated CT images (in breath hold) were acquired for one patient. Conventional planning target volume (PTV) and robust optimized plans (25GyE in single fraction) were simulated for both photon (IMRT, 5 and 9 beams) and proton (SFO, 2 beams) plans. Robust optimized plans were obtained both for protons and photons considering in the optimization setup errors (5 mm in the three orthogonal directions), range (±3.5%) and the clinical target volume (CTV) motion due to heartbeat and breath-hold variability. RESULTS: The photon robust optimization method, compared to PTV-based plans, showed a reduction in the average dose to the heart by about 25%; robust optimization allowed also reducing the mean dose to the left lung from 3.4. to 2.8 Gy for 9-beams configuration and from 4.1 to 2.9 Gy for 5-beams configuration. Robust optimization with protons, allowed further reducing the OAR doses: average dose to the heart and to the left lung decreased from 7.3 Gy to 5.2 GyE and from 2.9 Gy to 2.2 GyE, respectively. CONCLUSIONS: Our study demonstrates the importance of the optimization technique adopted in the treatment planning system for VT treatment. It has been shown that robust optimization can significantly reduce the dose to healthy cardiac tissues and that PT further increases this gain.
Authors: Rosalind Perrin; Patrick Maguire; Adriano Garonna; Georg Weidlich; Shelley Bulling; Marie Fargier-Voiron; Cedric De Marco; Eleonora Rossi; Mario Ciocca; Viviana Vitolo; Alfredo Mirandola Journal: Front Cardiovasc Med Date: 2022-05-04