MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose.

Carcinoma, Non-Small-Cell Lung / diagnostic imaging Humans Lung Lung Neoplasms / radiotherapy Radiosurgery Radiotherapy Dosage Radiotherapy Planning, Computer-Assisted Radiotherapy, Intensity-Modulated
Adaptive radiotherapy Lung SABR MLC tracking

Journal

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192

Informations de publication

Date de publication:
02 2021
Historique:
received: 12 08 2020
revised: 20 10 2020
accepted: 24 10 2020
pubmed: 6 11 2020
medline: 24 4 2021
entrez: 5 11 2020
Statut: ppublish

Résumé

The purpose of this work is to present the clinical experience from the first-in-human trial of real-time tumor targeting via MLC tracking for stereotactic ablative body radiotherapy (SABR) of lung lesions. Seventeen patients with stage 1 non-small cell lung cancer (NSCLC) or lung metastases were included in a study of electromagnetic transponder-guided MLC tracking for SABR (NCT02514512). Patients had electromagnetic transponders inserted near the tumor. An MLC tracking SABR plan was generated with planning target volume (PTV) expanded 5 mm from the end-exhale gross tumor volume (GTV). A clinically approved comparator plan was generated with PTV expanded 5 mm from a 4DCT-derived internal target volume (ITV). Treatment was delivered using a standard linear accelerator to continuously adapt the MLC based on transponder motion. Treated volumes and reconstructed delivered dose were compared between MLC tracking and comparator ITV-based treatment. All seventeen patients were successfully treated with MLC tracking (70 successful fractions). MLC tracking treatment delivery time averaged 8 minutes. The time from the start of CBCT to the end of treatment averaged 22 minutes. The MLC tracking PTV for 16/17 patients was smaller than the ITV-based PTV (range -1.6% to 44% reduction, or -0.6 to 18 cc). Reductions in mean lung dose (27 cGy) and V20Gy (50 cc) were statistically significant (p < 0.02). Reconstruction of treatment doses confirmed a statistically significant improvement in delivered GTV D98% (p < 0.05) from planned dose compared with the ITV-based plans. The first treatments with lung MLC tracking have been successfully performed in seventeen SABR patients. MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose.

Sections du résumé

BACKGROUND AND PURPOSE
The purpose of this work is to present the clinical experience from the first-in-human trial of real-time tumor targeting via MLC tracking for stereotactic ablative body radiotherapy (SABR) of lung lesions.
METHODS AND MATERIALS
Seventeen patients with stage 1 non-small cell lung cancer (NSCLC) or lung metastases were included in a study of electromagnetic transponder-guided MLC tracking for SABR (NCT02514512). Patients had electromagnetic transponders inserted near the tumor. An MLC tracking SABR plan was generated with planning target volume (PTV) expanded 5 mm from the end-exhale gross tumor volume (GTV). A clinically approved comparator plan was generated with PTV expanded 5 mm from a 4DCT-derived internal target volume (ITV). Treatment was delivered using a standard linear accelerator to continuously adapt the MLC based on transponder motion. Treated volumes and reconstructed delivered dose were compared between MLC tracking and comparator ITV-based treatment.
RESULTS
All seventeen patients were successfully treated with MLC tracking (70 successful fractions). MLC tracking treatment delivery time averaged 8 minutes. The time from the start of CBCT to the end of treatment averaged 22 minutes. The MLC tracking PTV for 16/17 patients was smaller than the ITV-based PTV (range -1.6% to 44% reduction, or -0.6 to 18 cc). Reductions in mean lung dose (27 cGy) and V20Gy (50 cc) were statistically significant (p < 0.02). Reconstruction of treatment doses confirmed a statistically significant improvement in delivered GTV D98% (p < 0.05) from planned dose compared with the ITV-based plans.
CONCLUSION
The first treatments with lung MLC tracking have been successfully performed in seventeen SABR patients. MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose.

Identifiants

DOI: 10.1016/j.radonc.2020.10.036 PMID: 33152399
pubmed: 33152399
pii: S0167-8140(20)30883-5
doi: 10.1016/j.radonc.2020.10.036
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT02514512']

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

131-137

Informations de copyright

Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.

Auteurs

Jeremy Booth (J)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Australia. Electronic address: Jeremy.Booth@health.nsw.gov.au.

Vincent Caillet (V)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; ACRF Image X Institute, Central Clinical School, University of Sydney, Australia.

Adam Briggs (A)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.

Nicholas Hardcastle (N)

Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia.

Georgios Angelis (G)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Australia.

Dasantha Jayamanne (D)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, University of Sydney, Australia.

Meegan Shepherd (M)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.

Alexander Podreka (A)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.

Kathryn Szymura (K)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.

Doan Trang Nguyen (DT)

ACRF Image X Institute, Central Clinical School, University of Sydney, Australia; School of Biomedical Engineering, University of Technology Sydney, Australia.

Per Poulsen (P)

Department of Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.

Ricky O'Brien (R)

ACRF Image X Institute, Central Clinical School, University of Sydney, Australia.

Benjamin Harris (B)

Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.

Carol Haddad (C)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.

Thomas Eade (T)

Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, University of Sydney, Australia.

Paul Keall (P)

ACRF Image X Institute, Central Clinical School, University of Sydney, Australia.

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Classifications MeSH

questionsmedicales.fr › Maladies de l'appareil respiratoire › Tumeurs de l'appareil respiratoire › Tumeurs du poumon › Tumeurs des bronches › Carcinome bronchogénique › Carcinome pulmonaire non à petites cellules › MLC tracking for lung SABR is feasible,...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › MLC tracking for lung SABR is feasible,...
questionsmedicales.fr › Appareil respiratoire › Poumon › MLC tracking for lung SABR is feasible,...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Tumeurs de l'appareil respiratoire › Tumeurs du poumon › MLC tracking for lung SABR is feasible,...
questionsmedicales.fr › Techniques d'investigation › Techniques stéréotaxiques › Radiochirurgie › MLC tracking for lung SABR is feasible,...
questionsmedicales.fr › Thérapeutique › Radiothérapie › Dosimétrie en radiothérapie › MLC tracking for lung SABR is feasible,...
questionsmedicales.fr › Sciences de l'information › Informatique › Informatique médicale › Applications de l'informatique médicale › Prise de décision assistée par ordinateur › Thérapie assistée par ordinateur › Radiothérapie assistée par ordinateur › Planification de radiothérapie assistée par ordinateur › MLC tracking for lung SABR is feasible,...
questionsmedicales.fr › Sciences de l'information › Informatique › Informatique médicale › Applications de l'informatique médicale › Prise de décision assistée par ordinateur › Thérapie assistée par ordinateur › Radiothérapie assistée par ordinateur › Radiothérapie conformationnelle › Radiothérapie conformationnelle avec modulation d'intensité › MLC tracking for lung SABR is feasible,...