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Abstract Purpose The purpose of this study was to compare carbon-ion (C-ion), proton and photon radiotherapy (RT) plans with regard to dose reduction of the gastrointestinal (GI) tract by using a greater omentum spacer (GO spacer). Methods We retrospectively retrieved data for ten patients who received the GO spacer as surgical spacer placement for abdominal and pelvic tumors. Simulation plans were created on pre-spacer Computed Tomography (CT) and post-spacer CT for C-ion RT, proton RT and photon RT to compare the dose of the GI tract. The plans were normalized so that at least 95% of the planning target volume (PTV) received 70 Gy (relative biological effectiveness equivalent) delivered in 35 fractions. All plans were created with the lowest possible dose to the GI tract under conditions that meet the dose constraints for the PTV and spinal cord (maximum dose

Abstract Background The aim of this study was to compare the plan quality of magnetic-resonance image-based intensity modulated radiation therapy (MRI-based-IMRT) with the MRIdian Linac system to that of volumetric modulated arc therapy (VMAT) with the TrueBeam STx system for lung stereotactic ablative radiotherapy (SABR). Methods A total of 22 patients with tumors located in the lower lobe were retrospectively selected for the study. For each patient, both the MRI-based-IMRT and VMAT plans were generated using an identical CT image set and identical structures with the exception of the planning target volume (PTV). The PTVs of the MRI-based-IMRT were generated by adding an isotropic margin of 3 mm from the gross tumor volume, whereas those of VMAT were generated by adding an isotropic margin of 5 mm from the internal target volume. For both the MRI-based-IMRT and VMAT, the prescription doses to the PTVs were 60 Gy in four fractions. Results The average PTV volume of the MRI-based-IMRT was approximately 4-times smaller than that of VMAT (p

Abstract Background Although there have been many attempts to increase the therapeutic ratio of radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma (MALToma), only a few planning studies have reported the efficacy of the modern radiotherapy technique till date. Therefore, we performed the dosimetric comparison among 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) plans, using deep-inspiration breath hold (DIBH) or free-breathing (FB) techniques, to determine the most optimal plan for gastric MALToma. Methods We evaluated 9 patients with gastric MALToma for whom 3D-CRT, step-and-shoot IMRT (SIMRT), volumetric-modulated arc therapy (VMAT), and tomotherapy plans with identical prescribed doses were generated using DIBH or FB computed tomography (CT). Planning target volume (PTV) coverage and non-target doses were calculated for each plan and compared with plan quality metric (PQM) scores. Results All 72 plans of 9 patients satisfied our dosimetric goals, and the IMRT plans and 3D-CRT plans had similarly good conformity index values with no differences related to respiratory movement. IMRT plans yielded significantly better doses to the organs-at-risk, and DIBH plans yielded significantly lower liver, heart, and lung Dmean and spinal cord Dmax with smaller irradiated volumes compared to FB plans. For the mean PQM scores, VMAT-DIBH and SIMRT-DIBH yielded the best scores, whereas 3D plans provided reduced beam monitor unit values. Conclusion Our findings demonstrate that modern RT technologies (DIBH with VMAT or SIMRT) could potentially provide excellent target coverage for gastric MALToma while reducing doses to organs-at-risk. However, the relevance of the most optimal plan considering clinical outcomes should be confirmed further in a larger patient cohort.

Abstract Background Automated treatment planning and/or optimization systems (ATPS) are in the process of broad clinical implementation aiming at reducing inter-planner variability, reducing the planning time allocated for the optimization process and improving plan quality. Five different ATPS used clinically were evaluated for advanced head and neck cancer (HNC). Methods Three radiation oncology departments compared 5 different ATPS: 1) Automatic Interactive Optimizer (AIO) in combination with RapidArc (in-house developed and Varian Medical Systems); 2) Auto-Planning (AP) (Philips Radiation Oncology Systems); 3) RapidPlan version 13.6 (RP1) with HNC model from University Hospital A (Varian Medical Systems, Palo Alto, USA); 4) RapidPlan version 13.7 (RP2) combined with scripting for automated setup of fields with HNC model from University Hospital B; 5) Raystation multicriteria optimization algorithm version 5 (RS) (Laboratories AB, Stockholm, Sweden). Eight randomly selected HNC cases from institution A and 8 from institution B were used. PTV coverage, mean and maximum dose to the organs at risk and effective planning time were compared. Ranking was done based on 3 Gy increments for the parallel organs. Results All planning systems achieved the hard dose constraints for the PTVs and serial organs for all patients. Overall, AP achieved the best ranking for the parallel organs followed by RS, AIO, RP2 and RP1. The oral cavity mean dose was the lowest for RS (31.3 ± 17.6 Gy), followed by AP (33.8 ± 17.8 Gy), RP1 (34.1 ± 16.7 Gy), AIO (36.1 ± 16.8 Gy) and RP2 (36.3 ± 16.2 Gy). The submandibular glands mean dose was 33.6 ± 10.8 Gy (AP), 35.2 ± 8.4 Gy (AIO), 35.5 ± 9.3 Gy (RP2), 36.9 ± 7.6 Gy (RS) and 38.2 ± 7.0 Gy (RP1). The average effective planning working time was substantially different between the five ATPS (in minutes):

Abstract Purpose Investigation of a reduced source to target distance to improve organ at risk sparing during stereotactic irradiation (STX). Methods The authors present a planning study with perfectly target-volume adapted collimator compared with multi-leaf collimator (MLC) at reduced source to virtual isocentre distance (SVID) in contrast to normal source to isocentre distance (SID) for stereotactic applications. The role of MLC leaf width and 20–80% penumbra was examined concerning the healthy tissue sparing. Several prescription schemes and target diameters are considered. Results Paddick’s gradient index (GI) as well as comparison of the mean doses to spherical shells at several distances to the target is evaluated. Both emphasize the same results: the healthy tissue sparing in the high dose area around the planning target volume (PTV) is improved at reduced SVID ≤ 70 cm. The effect can be attributed more to steeper penumbra than to finer leaf resolution. Comparing circular collimators at different SVID just as MLC-shaped collimators, always the GI was reduced. Even MLC-shaped collimator at SVID 70 cm had better healthy tissue sparing than an optimal shaped circular collimator at SID 100 cm. Regarding penumbra changes due to varying SVID, the results of the planning study are underlined by film dosimetry measurements with Agility™ MLC. Conclusion Penumbra requires more attention in comparing studies, especially studies using different planning systems. Reduced SVID probably allows usage of conventional MLC for STX-like irradiations.

Abstract Background Conventional step&shoot intensity modulated radio therapy (IMRT) approaches potentially lead to treatment plans with high numbers of segments and monitor units (MU) and, therefore, could be time consuming at the linear accelerator. Direct optimization methods are able to reduce the complexity without degrading the quality of the plan. The aim of this study is the evaluation of different IMRT approaches at standardized conditions for head and neck tumors. Method For 27 patients with carcinomas in the head and neck region a planning study with a 2-step-IMRT system (KonRad), a direct optimization system (Panther DAO) and a mixture of both approaches (MasterPlan DSS) was created. In order to avoid different prescription doses for boost volumes a simple standardization was realized. The dose was downscaled to 50 Gy to the planning target volume (PTV) which included the primary tumor as well as the bilateral lymphatic drainage (cervical and supraclavicular). Dose restrictions for the organs at risk (OAR) were downscaled to this prescription from high dose concepts up to 72 Gy. Those limits were defined as planning objectives while reaching definable PTV coverage with a standardized field setup. The parameters were evaluated from the corresponding dose volume histogram (DVH). Special attention was paid to the efficiency of the method, measured by means of calculated MU and required segments. Statistical tests of significance were applied to quantify the differences between the evaluated systems. Results PTV coverage for all systems in terms of V90% and V95% fell short of the requested 100% and 95%, respectively, but were still acceptable (range: 98.7% to 99.1% and 94.2% to 94.7%). Overall for OAR sparing and the burden of healthy tissue with low doses no technique was superior for all evaluated parameters. Differences were found for the number of segments where the direct optimization systems generated less segments. Lowest average numbers of MU were 308 by Panther DAO calculated for 2 Gy fractions. Based on these findings the treatment time at the linear accelerator is the lowest for Panther DAO. Conclusions All IMRT approaches implemented in the different treatment planning systems (TPS) generated clinically acceptable and comparable plans. No superior system in terms of PTV coverage and OAR sparing was found. Major differences in efficiency of the method in terms of calculated MU and treatment times were found.