Prog Med Phys.  2015 Jun;26(2):79-86. 10.14316/pmp.2015.26.2.79.

Feasibility and Efficacy of Adaptive Intensity Modulated Radiotherapy Planning according to Tumor Volume Change in Early Stage Non-small Cell Lung Cancer with Stereotactic Body Radiotherapy

• Park JW
• Kang MK
• Yea JW

• KMID: 1889939
• DOI: http://doi.org/10.14316/pmp.2015.26.2.79

Abstract

The purpose of this study is to evaluate efficacy and feasibility of adaptive radiotherapy according to tumor volume change (TVC) in early stage non-small cell lung cancer (NSCLC) using stereotactic body radiotherapy (SBRT). Twenty-two lesions previously treated with SBRT were selected. SBRT was usually performed with a total dose of 48 Gy or 60 Gy in four fractions with an interval of three to four days between treatments. For evaluation of TVC, gross tumor volume (GTV) was contoured on each cone-beam computed tomography (CBCT) image used for image guidance. Intensity modulated radiotherapy (IMRT) planning was performed in the first CBCT (CBCT1) using a baseline plan. For ART planning (ART), re-optimization was performed at 2nd, 3rd, and 4th CBCTs (CBCT2, CBCT3, and CBCT4) using the same angle and constraint used for the baseline plan. The ART plan was compared with the non-ART plan, which generated copying of the baseline plan to other CBCTs. Average GTV volume was 10.7 cc. Average TVC was -1.5%, 7.3%, and -25.1% in CBCT2, CBCT3, and CBCT4 and the TVC after CBCT3 was significant (p<0.05). However, the nine lesions were increased GTV in CBCT2. In the ART plan, V(20 Gy), D(1500 cc), and D(1000 cc) of lung were significantly decreased (p<0.05), and V(30 Gy) and V(32 Gy) of the chest wall were also decreased (p<0.05). While D min of planning target volume (PTV) decreased by 8.3% in the non-ART plan of CBCT2 compared with the baseline plan in lesions with increased tumor size (p=0.021), PTV coverage was not compromised in the ART plan. Based on this result, use of the ART plan may improve target coverage and OAR saving. Thus ART using CBCT should be considered in early stage NSCLC with SBRT.

Keyword

Stereotactic body radiotherapy; Lung cancer; Tumor volume; Adaptive planning

MeSH Terms

Carcinoma, Non-Small-Cell Lung*
Cone-Beam Computed Tomography
Lung
Lung Neoplasms
Radiosurgery*
Radiotherapy*
Thoracic Wall
Tumor Burden*

Figure

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  Fig. 1. Schematics of the planning procedure. (a) The intensity modulated radiotherapy (IMRT) plan was performed in 1st CBCT (baseline plan). (b) The beam angle and MLC motion of baseline plan was copied to other CBCTs. (c) The treatment isocenter was adjusted based on 3-dimensional registration data of each CBCT using the Varian offline review program (Varian Medical Systems Inc., Palo Alto, CA). (d) Non-adaptive plans were generated by direct calculation. Adaptive plans were generated by re-optimization process.

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  Fig. 2. The absolute and relative volume of GTV in all studied patients. (a) absolute GTV. (b) relative GTV.

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  Fig. 3. The gradual decrease of the average GTV volume.

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  Fig. 4. Differences of GTV change according to dose schedule. GTV in lesions treated with 15 Gy per fraction was significantly larger than the volume of tumors treated with less than 15 Gy per fraction (p=0.005).

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  Fig. 5. The dose-volume histogram of PTV coverage on the baseline plan in CBCT1, non-adaptive plan and adaptive plan of CBCT2. While Dmin was decreased by approximately 8.3% in non-ART (p＜0.021), PTV coverage was not compromised compared with the initial plan in the ART plan.

Reference

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