A prospective study on the effect of tumor shrinkage on exit fluence gamma pass rate in high precision radiotherapy and influence of phantom setup error in patient-specific quality assurance.
Journal
Journal of cancer research and therapeutics
ISSN: 1998-4138
Titre abrégé: J Cancer Res Ther
Pays: India
ID NLM: 101249598
Informations de publication
Date de publication:
01 Apr 2024
01 Apr 2024
Historique:
received:
15
11
2023
accepted:
19
03
2024
medline:
18
7
2024
pubmed:
18
7
2024
entrez:
18
7
2024
Statut:
ppublish
Résumé
Objective parameters for decision on adaptive radiotherapy depend on patient, tumor and treatment related factors. Present study reports geometric uncertainties occurring during high precision radiotherapy, beam fluence analysis and serial exit dose measurement as a patient-specific tool for adaptive radiotherapy. Serial exit dose fluence of 24 patients (at baseline and mid-treatment) undergoing IMRT/VMAT treatment were measured. Baseline and midtreatment exit dose evaluation was done using gafchromic films in predefined region of interest. Difference of volume of GTV at baseline (from simulation CT scan) and midtreatment CBCT scan was calculated (ΔGTV). Population based systematic errors (mm) were 4.15, 2.26, 0.88 and random errors (mm) were 2.56, 3.69, and 2.03 in mediolateral (ML), craniocaudal (CC) and anteroposterior (AP) directions respectively. Gamma pass rate reduced with incremental shift. For a 5 mm shift, maximum deviation was found in anteroposterior axis (22.16 ± 7.50) and lowest in mediolateral axis (12.85 ± 4.95). On serial measurement of exit dose fluence, tumor shrinkage significantly influenced gamma pass rate. The mean gamma pass rate was significantly different between groups with 50% shrinkage of tumor volume (86.36 vs 96.24, P = 0.008, on multivariate analysis P = 0.026). Rapid fall of gamma pass rate was observed for set up error of ≥3 mm. Serial measurement of exit dose fluence by radiochromic film is a feasible method of exit dose comparison in IMRT/VMAT, where EPID dosimetry is not available with linear accelerator configuration. Our study suggests that there is a significant difference between gamma pass rates of baseline and mid treatment exit dose fluence with greater than 50% tumor shrinkage.
Identifiants
pubmed: 39023601
doi: 10.4103/jcrt.jcrt_2472_23
pii: 01363817-202420030-00033
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
935-942Informations de copyright
Copyright © 2024 Copyright: © 2024 Journal of Cancer Research and Therapeutics.
Références
Esteyrie V, Gleyzolle B, Lusque A, Graff P, Modesto A, Rives M, et al. The GIRAFE phase II trial on MVCT-based “volumes of the day”and “dose of the day”addresses when and how to implement adaptive radiotherapy for locally advanced head and neck cancer. Clin Transl Radiat Oncol 2019;16:34–9.
Sonke J-J, Aznar M, Rasch C. Adaptive radiotherapy for anatomical changes. Semin Radiat Oncol 2019;29:245–57.
Piron O, Varfalvy N, Archambault L. Establishing action threshold for change in patient anatomy using EPID gamma analysis and PTV coverage for head and neck radiotherapy treatment. Med Phys 2018;45:3534–45.
Mijnheer B. EPID-based dosimetry and its relation to other 2D and 3D dose measurement techniques in radiation therapy. J Phys Conf Ser 2017;847:012024.
Ezzell GA, Burmeister JW, Dogan N, LoSasso TJ, Mechalakos JG, Mihailidis D, et al. IMRT commissioning:Multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119. Med Phys 2009;36:5359–73.
International Commission on Radiation Units and Measurements, editor. Prescribing, Recording, and Reporting Photon Beam Therapy. Bethesda, Md: International Commission on Radiation Units and Measurements; 1999. 52 p. (ICRU report).
Pramanik S, Ray DK, Bera S, Choudhury A, Iqbal A, Mondal S, et al. Analysis of setup uncertainties and determine the variation of the clinical target volume (CTV) to planning target volume (PTV) margin for various tumor sites treated with three-dimensional IGRT couch using KV-CBCT. J Radiat Oncol 2020;9:25–35.
OCTAVIUS Detector 1500XDR-PTW Freiburg GmbH. Available from : https://www.ptwdosimetry.com/en/products/octavius-detector-1500×dr/. [Last accessed on 2021 Dec 10].
OCTAVIUS 4D-PTW Freiburg GmbH. Available from: https://www.ptwdosimetry.com/en/products/octavius-4d-qa-phantom. [Last accessed on 2021 Dec 10].
Niroomand-Rad A, Blackwell CR, Coursey BM, Gall KP, Galvin JM, McLaughlin WL, et al. Radiochromic film dosimetry:Recommendations of AAPM Radiation Therapy Committee Task Group 55. Med Phys 1998;25:2093–115.
Niroomand-Rad A, Chiu-Tsao S-T, Grams M, Lewis D, Soares C, Battum LJ, et al. Report of AAPM task group 235 radiochromic film dosimetry:An update to TG-55. Med Phys 2020;47:5986–6025.
Das S, Isiah R, Rajesh B, Ravindran BP, Singh RR, Backianathan S, et al. Accuracy of relocation, evaluation of geometric uncertainties and clinical target volume (CTV) to planning target volume (PTV) margin in fractionated stereotactic radiotherapy for intracranial tumors using relocatable Gill-Thomas-Cosman (GTC) frame. J Appl Clin Med Phys 2011;12:29–38.
Srinivasan K, Mohammadi M, Shepherd J. Applications of linac-mounted kilovoltage Cone-beam Computed Tomography in modern radiation therapy:A review. Pol J Radiol 2014;79:181–93.
van Herk M. Errors and margins in radiotherapy. Semin Radiat Oncol 2004;14:52–64.
Hurkmans CW, Remeijer P, Lebesque JV, Mijnheer BJ. Set-up verification using portal imaging;review of current clinical practice. Radiother Oncol 2001;58:105–20.
Low DA. Gamma dose distribution evaluation tool. J Phys Conf Ser 2010;250:012071.
Hussein M, Rowshanfarzad P, Ebert MA, Nisbet A, Clark CH. A comparison of the gamma index analysis in various commercial IMRT/VMAT QA systems. Radiother Oncol J Eur Soc Ther Radiol Oncol 2013;109:370–6.
Zhang D, Wang B, Zhang G, Ma C, Deng X. Comparison of 3D and 2D gamma passing rate criteria for detection sensitivity to IMRT delivery errors. J Appl Clin Med Phys 2018;19:230–8.
Vincent B, Balasingh TP, Raj L JS, Singh RR, Sebastian T, Isiah R, et al. Standardizing serial exit fluence mapping and implementing its clinical use to predict the need for adaptive re-planning in head and neck IMRT. Int J Radiat Oncol 2018;102:e540–1.
Vieillevigne L, Molinier J, Brun T, Ferrand R. Gamma index comparison of three VMAT QA systems and evaluation of their sensitivity to delivery errors. Phys Med 2015;31:720–5.
Nelms BE, Zhen H, Tomé WA. Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose errors:Predicative power of conventional IMRT QA. Med Phys 2011;38:1037–44.
Nelms BE, Chan MF, Jarry G, Lemire M, Lowden J, Hampton C, et al. Evaluating IMRT and VMAT dose accuracy:Practical examples of failure to detect systematic errors when applying a commonly used metric and action levels. Med Phys 2013;40:111722. doi:10.1118/1.4826166.
doi: 10.1118/1.4826166
Gadhi MA, Azeem N, Azeem A, Fatmi S, Nazir A, Buzdar SA. Quantitative measurements for entrance and exit radiation dose confirmation for cancer patients:An analysis of large cohort of patients. Int J Radiat Res 2019;17:423–28.
Barker JL Jr, Garden AS, Ang KK, O'Daniel JC, Wang H, Court LE, et al. Quantification of volumetric and geometric changes occurring during fractionated radiotherapy for head-and-neck cancer using an integrated CT/linear accelerator system. Int J Radiat Oncol Biol Phys 2004;59:960–70.
Moon S, Jo Y, Seo J, Shin D, Yoon M. Inter-fractional entrance dose monitoring as quality assurance using Gafchromic EBT3 film. J Cancer Res Ther 2022;18:1152–8.
Axford A, Dikaios N, Roberts DA, Clark CH, Evans PM. An end-to-end assessment on the accuracy of adaptive radiotherapy in an MR-linac. Phys Med Biol 2021;66:055021.
McCaw TJ, Micka JA, DeWerd LA. Development and characterization of a three-dimensional radiochromic film stack dosimeter for megavoltage photon beam dosimetry:Development and characterization of a film stack dosimeter. Med Phys 2014;41:052104.
Sukumar P, Padmanaban S, Rajasekaran D, Kannan M, Nagarajan V. Exit fluence analysis using portal dosimetry in volumetric modulated arc therapy. Rep Pract Oncol Radiother 2012;17:324–31.
Gardner JK, Clews L, Gordon JJ, Wang S, Greer PB, Siebers JV. Comparison of sources of exit fluence variation for IMRT. Phys Med Biol 2009;54:N451–8.
Bojechko C, Ford EC. Quantifying the performance of in vivo portal dosimetry in detecting four types of treatment parameter variations:Quantifying the performance of in vivo portal dosimetry. Med Phys 2015;42:6912–8.