A comprehensive dosimetric study on switching from a Type-B to a Type-C dose algorithm for modern lung SBRT

Christina Zhou, Nathan Bennion, Rongtao Ma, Xiaoying Liang, Shuo Wang, Kristina Zvolanek, Megan A Hyun, Xiaobo Li, Sumin Zhou, Weining Zhen, Chi Lin, Andrew O Wahl, Dandan Zheng

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Abstract

Background: Type-C dose algorithms provide more accurate dosimetry for lung SBRT treatment planning. However, because current dosimetric protocols were developed based on conventional algorithms, its applicability for the new generation algorithms needs to be determined. Previous studies on this issue used small sample sizes and reached discordant conclusions. Our study assessed dose calculation of a Type-C algorithm with current dosimetric protocols in a large patient cohort, in order to demonstrate the dosimetric impacts and necessary treatment planning steps of switching from a Type-B to a Type-C dose algorithm for lung SBRT planning. Methods: Fifty-two lung SBRT patients were included, each planned using coplanar VMAT arcs, normalized to D95% = prescription dose using a Type-B algorithm. These were compared against three Type-C plans: re-calculated plans (identical plan parameters), re-normalized plans (D95% = prescription dose), and re-optimized plans. Dosimetric endpoints were extracted and compared among the four plans, including RTOG dosimetric criteria: (R100%, R50%, D2cm, V105%, and lung V20), PTV Dmin, Dmax, Dmean, V% and D90%, PTV coverage (V100%), homogeneity index (HI), and Paddick conformity index (PCI). Results: Re-calculated Type-C plans resulted in decreased PTV Dmin with a mean difference of 5.2% and increased Dmax with a mean difference of 3.1%, similar or improved RTOG dose compliance, but compromised PTV coverage (mean D95% and V100% reduction of 2.5 and 8.1%, respectively). Seven plans had >5% D95% reduction (maximum reduction = 16.7%), and 18 plans had >5%V100% reduction (maximum reduction = 60.0%). Re-normalized Type-C plans restored target coverage, but yielded degraded plan conformity (average PCI reduction 4.0%), and RTOG dosimetric criteria deviation worsened in 11 plans, in R50%, D2cm, and R100%. Except for one case, re-optimized Type-C plans restored RTOG compliance achieved by the original Type-B plans, resulting in similar dosimetric values but slightly higher target dose heterogeneity (mean HI increase = 13.2%). Conclusions: Type-B SBRT lung plans considerably overestimate target coverage for some patients, necessitating Type-C re-normalization or re-optimization. Current RTOG dosimetric criteria appear to remain appropriate.

Original languageEnglish (US)
Article number80
JournalRadiation Oncology
Volume12
Issue number1
DOIs
StatePublished - May 5 2017

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Lung
Compliance
Prescriptions
Levonorgestrel
Sample Size
Therapeutics

Keywords

  • Dose algorithms
  • Lung
  • Monte carlo
  • SBRT
  • VMAT

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

A comprehensive dosimetric study on switching from a Type-B to a Type-C dose algorithm for modern lung SBRT. / Zhou, Christina; Bennion, Nathan; Ma, Rongtao; Liang, Xiaoying; Wang, Shuo; Zvolanek, Kristina; Hyun, Megan A; Li, Xiaobo; Zhou, Sumin; Zhen, Weining; Lin, Chi; Wahl, Andrew O; Zheng, Dandan.

In: Radiation Oncology, Vol. 12, No. 1, 80, 05.05.2017.

Research output: Contribution to journalArticle

Zhou, Christina ; Bennion, Nathan ; Ma, Rongtao ; Liang, Xiaoying ; Wang, Shuo ; Zvolanek, Kristina ; Hyun, Megan A ; Li, Xiaobo ; Zhou, Sumin ; Zhen, Weining ; Lin, Chi ; Wahl, Andrew O ; Zheng, Dandan. / A comprehensive dosimetric study on switching from a Type-B to a Type-C dose algorithm for modern lung SBRT. In: Radiation Oncology. 2017 ; Vol. 12, No. 1.
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abstract = "Background: Type-C dose algorithms provide more accurate dosimetry for lung SBRT treatment planning. However, because current dosimetric protocols were developed based on conventional algorithms, its applicability for the new generation algorithms needs to be determined. Previous studies on this issue used small sample sizes and reached discordant conclusions. Our study assessed dose calculation of a Type-C algorithm with current dosimetric protocols in a large patient cohort, in order to demonstrate the dosimetric impacts and necessary treatment planning steps of switching from a Type-B to a Type-C dose algorithm for lung SBRT planning. Methods: Fifty-two lung SBRT patients were included, each planned using coplanar VMAT arcs, normalized to D95{\%} = prescription dose using a Type-B algorithm. These were compared against three Type-C plans: re-calculated plans (identical plan parameters), re-normalized plans (D95{\%} = prescription dose), and re-optimized plans. Dosimetric endpoints were extracted and compared among the four plans, including RTOG dosimetric criteria: (R100{\%}, R50{\%}, D2cm, V105{\%}, and lung V20), PTV Dmin, Dmax, Dmean, V{\%} and D90{\%}, PTV coverage (V100{\%}), homogeneity index (HI), and Paddick conformity index (PCI). Results: Re-calculated Type-C plans resulted in decreased PTV Dmin with a mean difference of 5.2{\%} and increased Dmax with a mean difference of 3.1{\%}, similar or improved RTOG dose compliance, but compromised PTV coverage (mean D95{\%} and V100{\%} reduction of 2.5 and 8.1{\%}, respectively). Seven plans had >5{\%} D95{\%} reduction (maximum reduction = 16.7{\%}), and 18 plans had >5{\%}V100{\%} reduction (maximum reduction = 60.0{\%}). Re-normalized Type-C plans restored target coverage, but yielded degraded plan conformity (average PCI reduction 4.0{\%}), and RTOG dosimetric criteria deviation worsened in 11 plans, in R50{\%}, D2cm, and R100{\%}. Except for one case, re-optimized Type-C plans restored RTOG compliance achieved by the original Type-B plans, resulting in similar dosimetric values but slightly higher target dose heterogeneity (mean HI increase = 13.2{\%}). Conclusions: Type-B SBRT lung plans considerably overestimate target coverage for some patients, necessitating Type-C re-normalization or re-optimization. Current RTOG dosimetric criteria appear to remain appropriate.",
keywords = "Dose algorithms, Lung, Monte carlo, SBRT, VMAT",
author = "Christina Zhou and Nathan Bennion and Rongtao Ma and Xiaoying Liang and Shuo Wang and Kristina Zvolanek and Hyun, {Megan A} and Xiaobo Li and Sumin Zhou and Weining Zhen and Chi Lin and Wahl, {Andrew O} and Dandan Zheng",
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AU - Zhou, Christina

AU - Bennion, Nathan

AU - Ma, Rongtao

AU - Liang, Xiaoying

AU - Wang, Shuo

AU - Zvolanek, Kristina

AU - Hyun, Megan A

AU - Li, Xiaobo

AU - Zhou, Sumin

AU - Zhen, Weining

AU - Lin, Chi

AU - Wahl, Andrew O

AU - Zheng, Dandan

PY - 2017/5/5

Y1 - 2017/5/5

N2 - Background: Type-C dose algorithms provide more accurate dosimetry for lung SBRT treatment planning. However, because current dosimetric protocols were developed based on conventional algorithms, its applicability for the new generation algorithms needs to be determined. Previous studies on this issue used small sample sizes and reached discordant conclusions. Our study assessed dose calculation of a Type-C algorithm with current dosimetric protocols in a large patient cohort, in order to demonstrate the dosimetric impacts and necessary treatment planning steps of switching from a Type-B to a Type-C dose algorithm for lung SBRT planning. Methods: Fifty-two lung SBRT patients were included, each planned using coplanar VMAT arcs, normalized to D95% = prescription dose using a Type-B algorithm. These were compared against three Type-C plans: re-calculated plans (identical plan parameters), re-normalized plans (D95% = prescription dose), and re-optimized plans. Dosimetric endpoints were extracted and compared among the four plans, including RTOG dosimetric criteria: (R100%, R50%, D2cm, V105%, and lung V20), PTV Dmin, Dmax, Dmean, V% and D90%, PTV coverage (V100%), homogeneity index (HI), and Paddick conformity index (PCI). Results: Re-calculated Type-C plans resulted in decreased PTV Dmin with a mean difference of 5.2% and increased Dmax with a mean difference of 3.1%, similar or improved RTOG dose compliance, but compromised PTV coverage (mean D95% and V100% reduction of 2.5 and 8.1%, respectively). Seven plans had >5% D95% reduction (maximum reduction = 16.7%), and 18 plans had >5%V100% reduction (maximum reduction = 60.0%). Re-normalized Type-C plans restored target coverage, but yielded degraded plan conformity (average PCI reduction 4.0%), and RTOG dosimetric criteria deviation worsened in 11 plans, in R50%, D2cm, and R100%. Except for one case, re-optimized Type-C plans restored RTOG compliance achieved by the original Type-B plans, resulting in similar dosimetric values but slightly higher target dose heterogeneity (mean HI increase = 13.2%). Conclusions: Type-B SBRT lung plans considerably overestimate target coverage for some patients, necessitating Type-C re-normalization or re-optimization. Current RTOG dosimetric criteria appear to remain appropriate.

AB - Background: Type-C dose algorithms provide more accurate dosimetry for lung SBRT treatment planning. However, because current dosimetric protocols were developed based on conventional algorithms, its applicability for the new generation algorithms needs to be determined. Previous studies on this issue used small sample sizes and reached discordant conclusions. Our study assessed dose calculation of a Type-C algorithm with current dosimetric protocols in a large patient cohort, in order to demonstrate the dosimetric impacts and necessary treatment planning steps of switching from a Type-B to a Type-C dose algorithm for lung SBRT planning. Methods: Fifty-two lung SBRT patients were included, each planned using coplanar VMAT arcs, normalized to D95% = prescription dose using a Type-B algorithm. These were compared against three Type-C plans: re-calculated plans (identical plan parameters), re-normalized plans (D95% = prescription dose), and re-optimized plans. Dosimetric endpoints were extracted and compared among the four plans, including RTOG dosimetric criteria: (R100%, R50%, D2cm, V105%, and lung V20), PTV Dmin, Dmax, Dmean, V% and D90%, PTV coverage (V100%), homogeneity index (HI), and Paddick conformity index (PCI). Results: Re-calculated Type-C plans resulted in decreased PTV Dmin with a mean difference of 5.2% and increased Dmax with a mean difference of 3.1%, similar or improved RTOG dose compliance, but compromised PTV coverage (mean D95% and V100% reduction of 2.5 and 8.1%, respectively). Seven plans had >5% D95% reduction (maximum reduction = 16.7%), and 18 plans had >5%V100% reduction (maximum reduction = 60.0%). Re-normalized Type-C plans restored target coverage, but yielded degraded plan conformity (average PCI reduction 4.0%), and RTOG dosimetric criteria deviation worsened in 11 plans, in R50%, D2cm, and R100%. Except for one case, re-optimized Type-C plans restored RTOG compliance achieved by the original Type-B plans, resulting in similar dosimetric values but slightly higher target dose heterogeneity (mean HI increase = 13.2%). Conclusions: Type-B SBRT lung plans considerably overestimate target coverage for some patients, necessitating Type-C re-normalization or re-optimization. Current RTOG dosimetric criteria appear to remain appropriate.

KW - Dose algorithms

KW - Lung

KW - Monte carlo

KW - SBRT

KW - VMAT

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