Multicenter Study

. 2017 Oct;193(10):780-790.

doi: 10.1007/s00066-017-1151-8. Epub 2017 May 31.

Planning benchmark study for SBRT of early stage NSCLC : Results of the DEGRO Working Group Stereotactic Radiotherapy

Christos Moustakis^{1

2}, Oliver Blanck^{3

4}, Fatemeh Ebrahimi Tazehmahalleh^{5

6}, Mark Ka Heng Chan³, Iris Ernst^{5

7}, Thomas Krieger⁸, Marciana-Nona Duma⁹, Markus Oechsner⁹, Ute Ganswindt¹⁰, Christian Heinz¹⁰, Horst Alheit¹¹, Hilbert Blank¹¹, Ursula Nestle¹², Rolf Wiehle¹², Christine Kornhuber¹³, Christian Ostheimer¹³, Cordula Petersen¹⁴, Gerhard Pollul¹⁵, Wolfgang Baus¹⁶, Georg Altenstein¹⁶, Eric Beckers¹⁷, Katrin Jurianz¹⁷, Florian Sterzing¹⁸, Matthias Kretschmer¹⁹, Heinrich Seegenschmiedt²⁰, Torsten Maass²⁰, Stefan Droege²¹, Ulrich Wolf²², Juergen Schoeffler²³, Uwe Haverkamp^{5

7}, Hans Theodor Eich^{5

7}, Matthias Guckenberger²⁴

Affiliations

¹ Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. christos.moustakis@ukmuenster.de.
² German CyberKnife Center, Soest, Germany. christos.moustakis@ukmuenster.de.
³ Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig Holstein, Kiel, Germany.
⁴ Güstrow and Frankfurt, Saphir Radiosurgery Center, Frankfurt, Germany.
⁵ Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
⁶ City Hospital Dessau, Dessau, Germany.
⁷ German CyberKnife Center, Soest, Germany.
⁸ Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany.
⁹ Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
¹⁰ Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
¹¹ Radiationtherapy Distler, Bautzen, Germany.
¹² Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.
¹³ Department of Radiation Oncology, University Halle, Halle, Germany.
¹⁴ University Hospital Hamburg-Eppendorf, Hamburg, Germany.
¹⁵ Department of Radiation Oncology, University Mainz, Mainz, Germany.
¹⁶ University Hospital of Cologne, Cologne, Germany.
¹⁷ Gamma Knife Center Krefeld, Krefeld, Germany.
¹⁸ University Hospital Heidelberg, Heidelberg, Germany.
¹⁹ Radiologische Allianz Hamburg, Hamburg, Germany.
²⁰ Radiationtherapy and Cyberknife Center Hamburg, Hamburg, Germany.
²¹ Lung Clinic Hemer, Hemer, Germany.
²² Department of Radiation Oncology, University Leipzig, Leipzig, Germany.
²³ Radiationtherapy Department Boeblingen, Boeblingen, Germany.
²⁴ Department of Radiation Oncology, University Zurich, Zurich, Switzerland.

PMID: 28567503
DOI: 10.1007/s00066-017-1151-8

Multicenter Study

Planning benchmark study for SBRT of early stage NSCLC : Results of the DEGRO Working Group Stereotactic Radiotherapy

Christos Moustakis et al. Strahlenther Onkol. 2017 Oct.

. 2017 Oct;193(10):780-790.

doi: 10.1007/s00066-017-1151-8. Epub 2017 May 31.

Authors

Affiliations

¹ Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. christos.moustakis@ukmuenster.de.
² German CyberKnife Center, Soest, Germany. christos.moustakis@ukmuenster.de.
³ Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig Holstein, Kiel, Germany.
⁴ Güstrow and Frankfurt, Saphir Radiosurgery Center, Frankfurt, Germany.
⁵ Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
⁶ City Hospital Dessau, Dessau, Germany.
⁷ German CyberKnife Center, Soest, Germany.
⁸ Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany.
⁹ Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
¹⁰ Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
¹¹ Radiationtherapy Distler, Bautzen, Germany.
¹² Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.
¹³ Department of Radiation Oncology, University Halle, Halle, Germany.
¹⁴ University Hospital Hamburg-Eppendorf, Hamburg, Germany.
¹⁵ Department of Radiation Oncology, University Mainz, Mainz, Germany.
¹⁶ University Hospital of Cologne, Cologne, Germany.
¹⁷ Gamma Knife Center Krefeld, Krefeld, Germany.
¹⁸ University Hospital Heidelberg, Heidelberg, Germany.
¹⁹ Radiologische Allianz Hamburg, Hamburg, Germany.
²⁰ Radiationtherapy and Cyberknife Center Hamburg, Hamburg, Germany.
²¹ Lung Clinic Hemer, Hemer, Germany.
²² Department of Radiation Oncology, University Leipzig, Leipzig, Germany.
²³ Radiationtherapy Department Boeblingen, Boeblingen, Germany.
²⁴ Department of Radiation Oncology, University Zurich, Zurich, Switzerland.

PMID: 28567503
DOI: 10.1007/s00066-017-1151-8

Abstract

Purpose: The aim was to evaluate stereotactic body radiation therapy (SBRT) treatment planning variability for early stage nonsmall cell lung cancer (NSCLC) with respect to the published guidelines of the Stereotactic Radiotherapy Working Group of the German Society for Radiation Oncology (DEGRO).

Materials and methods: Planning computed tomography (CT) scan and the structure sets (planning target volume, PTV; organs at risk, OARs) of 3 patients with early stage NSCLC were sent to 22 radiotherapy departments with SBRT experience: each department was asked to prepare a treatment plan according to the DEGRO guidelines. The prescription dose was 3 fractions of 15 Gy to the 65% isodose.

Results: In all, 87 plans were generated: 36 used intensity-modulated arc therapy (IMAT), 21 used three-dimensional conformal radiation therapy (3DCRT), 6 used static field intensity-modulated radiation therapy (SF-IMRT), 9 used helical radiotherapy and 15 used robotic radiosurgery. PTV dose coverage and simultaneously kept OARs doses were within the clinical limits published in the DEGRO guidelines. However, mean PTV dose (mean 58.0 Gy, range 52.8-66.4 Gy) and dose conformity indices (mean 0.75, range 0.60-1.00) varied between institutions and techniques (p ≤ 0.02). OARs doses varied substantially between institutions, but appeared to be technique independent (p = 0.21).

Conclusion: All studied treatment techniques are well suited for SBRT of early stage NSCLC according to the DEGRO guidelines. Homogenization of SBRT practice in Germany is possible through the guidelines; however, detailed treatment plan characteristics varied between techniques and institutions and further homogenization is warranted in future studies and recommendations. Optimized treatment planning should always follow the ALARA (as low as reasonably achievable) principle.

Keywords: Nonsmall cell lung cancer; Organs at risk; Planning benchmark study; Quality assurance; Stereotactic radiation therapy.

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Comment in

Time for crowd knowledge-based approach in SBRT planning.
Mancosu P, Esposito M, Giglioli F, Stasi M; Italian medical physicist SBRT working group. Mancosu P, et al. Strahlenther Onkol. 2017 Dec;193(12):1066-1067. doi: 10.1007/s00066-017-1214-x. Epub 2017 Sep 13. Strahlenther Onkol. 2017. PMID: 28905198 English. No abstract available.
Time for standardization of SBRT planning through large scale clinical data and guideline-based approaches.
Moustakis C, Blanck O, Ebrahimi F, Ka Heng Chan M, Ernst I, Krieger T, Duma MN, Oechsner M, Ganswindt U, Heinz C, Alheit H, Blank H, Nestle U, Wiehle R, Kornhuber C, Ostheimer C, Petersen C, Pollul G, Baus W, Altenstein G, Beckers E, Jurianz K, Sterzing F, Kretschmer M, Seegenschmiedt H, Maass T, Droege S, Wolf U, Schoeffler J, Haverkamp U, Eich H, Guckenberger M. Moustakis C, et al. Strahlenther Onkol. 2017 Dec;193(12):1068-1069. doi: 10.1007/s00066-017-1216-8. Epub 2017 Sep 15. Strahlenther Onkol. 2017. PMID: 28916902 English. No abstract available.

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Planning benchmark study for SBRT of early stage NSCLC : Results of the DEGRO Working Group Stereotactic Radiotherapy

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Planning benchmark study for SBRT of early stage NSCLC : Results of the DEGRO Working Group Stereotactic Radiotherapy

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