Technical Note: A step-by-step guide to Temporally Feathered Radiation Therapy planning for head and neck cancer
Technical Note: A step-by-step guide to Temporally Feathered Radiation Therapy planning for head and neck cancer
复制标题
DOI：
10.1002/acm2.12893
复制
发表时间：
2020-05-08
影响因子：
2.1
通讯作者：
Scott, Jacob G.
中科院分区：
文献类型：
--
作者：
Parsai, Shireen;Qiu, Richard L. J.;Scott, Jacob G.
目的：先前的计算机模拟表明，时间羽状放射治疗（TFRT）可能会减少与头颈部放射治疗相关的毒性。在这项研究中，我们展示了一步一步的指导TFRT规划与现代治疗planning systems.Methods一个病人口咽癌计划为确定性放射治疗使用调强放射治疗（IMRT）技术重新计划使用TFRT技术。五个危险器官（OAR）被确定为羽状。首先根据所需的计划目标体积（PTV）覆盖范围、计划一致性和OAR约束条件创建“基础计划”。然后，通过修改规划目标，重新优化基本计划，生成五个子计划。将每个子计划中的所有射束导入到一个试验中，以创建复合TFRT计划。将复合TFRT计划与非TFRT IMRT计划直接进行比较。在计划评估，复合TFRT首先进行评估，然后由每个子计划，以满足预设的合规criteria.Results以下器官羽毛：口腔，右颌下腺，左颌下腺，声门上，OAR咽。处方剂量PTV覆盖率（>95%）在每个子计划和复合TFRT计划中均得到满足。在计划中观察到预期的剂量小变化。高剂量分数和平均低剂量分数之间的百分比变化分别为29%，28%，24%，19%，和10%的口腔，右下颌下，左下颌下，声门上，和OAR咽不重叠的PTV.Conclusions时间羽毛放射治疗计划是可能的现代治疗计划系统。与非TFRT IMRT计划相比，TFRT计划观察到适度的剂量学变化。我们等待当前前瞻性试验的结果，以寻求证明TFRT在现代临床工作流程中的可行性（NCT 03768856）。需要进一步研究来证明TFRT相对于非TFRT IMRT计划的潜在受益。
Purpose Prior in silico simulations propose that Temporally Feathered Radiation Therapy (TFRT) may reduce toxicity related to head and neck radiation therapy. In this study we demonstrate a step-by-step guide to TFRT planning with modern treatment planning systems.Methods One patient with oropharyngeal cancer planned for definitive radiation therapy using intensity-modulated radiation therapy (IMRT) techniques was replanned using the TFRT technique. Five organs at risk (OAR) were identified to be feathered. A "base plan" was first created based on desired planning target volumes (PTV) coverage, plan conformality, and OAR constraints. The base plan was then re-optimized by modifying planning objectives, to generate five subplans. All beams from each subplan were imported onto one trial to create the composite TFRT plan. The composite TFRT plan was directly compared with the non-TFRT IMRT plan. During plan assessment, the composite TFRT was first evaluated followed by each subplan to meet preset compliance criteria.Results The following organs were feathered: oral cavity, right submandibular gland, left submandibular gland, supraglottis, and OAR Pharynx. Prescription dose PTV coverage (>95%) was met in each subplan and the composite TFRT plan. Expected small variations in dose were observed among the plans. The percent variation between the high fractional dose and average low fractional dose was 29%, 28%, 24%, 19%, and 10% for the oral cavity, right submandibular, left submandibular, supraglottis, and OAR pharynx nonoverlapping with the PTV.Conclusions Temporally Feathered Radiation Therapy planning is possible with modern treatment planning systems. Modest dosimetric changes are observed with TFRT planning compared with non-TFRT IMRT planning. We await the results of the current prospective trial to seeking to demonstrate the feasibility of TFRT in the modern clinical workflow (NCT03768856). Further studies will be required to demonstrate the potential benefit of TFRT over non-TFRT IMRT Planning.