VMAT Grid Therapy: A Widely Applicable Planning Approach
VMAT Grid Therapy: A Widely Applicable Planning Approach
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DOI：
10.1016/j.prro.2020.10.007
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发表时间：
2021-04-30
影响因子：
3.3
通讯作者：
Ma, Daniel J.
中科院分区：
文献类型：
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作者：
Grams, Michael P.;Owen, Dawn;Ma, Daniel J.
目的：描述一种新的、实用的体积调制弧形治疗(VMAT)网格治疗规划方法。方法和材料：剂量规定为直径1.5 cm的球状轮廓，放置在整个大体肿瘤体积(GTV)中。球体的位置是可变的，但它们必须保持至少3厘米(中心到中心)的间隔，并且任何球体的边缘必须距离任何危险器官(OAR)至少1厘米。在优化过程中使用了三个同心环结构，以将最高剂量限制在球体的中心，并最大限度地节省球体之间的剂量。最终结果是在整个GTV中交替使用高剂量和低剂量区域，并对桨进行最小剂量的照射。高强度平坦化无滤光片(FFF)模式被用来有效地提供计划，整个治疗通常只需要15到20分钟。结果：该方法以我所治疗的2例为例进行了说明。患者#1纵隔肿块大小为1703-cm3，GTV内24个球形区域的治疗剂量为20Gray(伽玛刀)。患者2有一个3680厘米的腹部肿瘤，在GTV内开出了18Gy32个球形区域的处方。这两名患者在最初的VMAT格栅治疗后大约一周接受了额外的巩固放射治疗。每个患者都经历了明显的肿瘤缩小和症状缓解，没有治疗相关的并发症。结论：我们详细描述了一种VMAT网格治疗的规划方法，该方法通常可以在临床实用的时间跨度内提供。VMAT方法对于被敏感的关键结构包围的肿瘤特别有用。由于许多中心提供VMAT治疗，该方法可广泛使用，并可在建立适当的患者选择和交付程序后立即实施。(C) ；2020作者(S)。由爱思唯尔公司代表美国放射肿瘤学会出版。这是CC BY-NC-ND License(http://creativecommons.org/licenses/by-nc-nd/4.0/).下的一篇开放获取文章
Purpose: To describe a novel and practical volumetric modulated arc therapy (VMAT) planning approach for grid therapy.Methods and Materials: Dose is prescribed to 1.5-cm diameter spherical contours placed throughout the gross tumor volume (GTV). Placement of spheres is variable, but they must maintain at least a 3-cm (center to center) separation, and the edge of any sphere must be at least 1 cm from any organ at risk (OAR). Three concentric ring structures are used during optimization to confine the highest doses to the center of the spheres and maximize dose sparing between them. The end result is alternating regions of high and low dose throughout the GTV and minimal dose to OARs. High-intensity flattening filter-free (FFF) modes are used to efficiently deliver the plans, and entire treatments typically take only 15 to 20 minutes.Results: The approach is illustrated with 2 examples treated at our institution. Patient #1 had a 1703-cm3 mediastinal mass and was prescribed 20 Gray (Gy) to 24 spherical regions within the GTV. Patient #2 had a 3680-cm3 abdominal tumor and was prescribed 18 Gy to 32 spherical regions within the GTV. Both patients received additional consolidative radiation approximately 1 week after the initial VMAT grid treatment. Each patient experienced marked reduction in tumor size and symptomatic relief without treatment-related complications.Conclusions: We have described in detail a planning approach for VMAT grid therapy treatments that can typically be delivered in a clinically practical time span. The VMAT approach is especially useful for tumors that are surrounded by sensitive critical structures. As many centers offer VMAT treatments, the approach is widely accessible and can be readily implemented once appropriate patient selection and delivery processes are established.(C)& nbsp;2020 The Author(s). Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).