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. 2020 Sep 10;15(1):215.
doi: 10.1186/s13014-020-01657-6.

Radiotherapy in oncological emergencies: fast-track treatment planning

Lukas Nierer  1 , Franziska Walter  2 , Maximilian Niyazi  2 , Roel Shpani  2 , Guillaume Landry  2 , Sebastian Marschner  2 , Rieke von Bestenbostel  2 , Dominika Dinkel  2 , Gabriela Essenbach  2 , Michael Reiner  2 , Claus Belka  2 , Stefanie Corradini  2
Affiliations

Radiotherapy in oncological emergencies: fast-track treatment planning

Lukas Nierer et al. Radiat Oncol. .

Abstract

Background and purpose: To report on our clinical experience with a newly implemented workflow for radiotherapy (RT) emergency treatments, which allows for a fast treatment application outside the regular working-hours, and its clinical applicability.

Methods: Treatment planning of 18 emergency RT patients was carried out using diagnostic computed tomography (CT) without a dedicated RT simulation CT. The cone-beam CT (CBCT) deviations of the first RT treatment were analyzed regarding setup accuracy. Furthermore, feasibility of the "fast-track" workflow was evaluated with respect to dose deviations caused by different Hounsfield unit (HU) to relative electron density (rED) calibrations and RT treatment couch surface shapes via 3D gamma index analysis of exemplary treatment plans. The dosimetric uncertainty introduced by different CT calibrations was quantified.

Results: Mean patient setup vs. CBCT isocenter deviations were (0.49 ± 0.44) cm (x), (2.68 ± 1.63) cm (y) and (1.80 ± 1.06) cm (z) for lateral, longitudinal and vertical directions, respectively. Three out of four dose comparisons between the emergency RT plan calculated on the diagnostic CT and the same plan calculated on the treatment planning CT showed clinically acceptable gamma passing rates, when correcting for surface artifacts. The maximum difference of rED was 0.054, while most parts of the CT calibration curves coincided well.

Conclusion: In an emergency RT setting, the use of diagnostic CT data for treatment planning might be time-saving and was shown to be suitable for many cases, considering reproducibility of patient setup, accuracy of initial patient setup and accuracy of dose-calculation.

Keywords: Emergency RT workflow; Emergency radiation treatment; Fast treatment planning; Rapid planning; Treatment planning on diagnostic CT.

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Conflict of interest statement

CB and SC received speaker honoraria and research grants from ELEKTA AB (Stockholm, Sweden) and C-Rad AB (Upsala, Sweden). The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
“Fast-track” emergency RT workflow
Fig. 2
Fig. 2
Boxplots of initial patient setup versus CBCT isocenter correction values in lateral (x), longitudinal (y) and vertical (z) direction of all patients (n = 18)
Fig. 3
Fig. 3
Exemplary 3D conformal emergency treatment plan dose distributions on axial slices of patient 1 (re-planned after 1st fraction) and the resulting dose difference map: a original plan calculated on diagnostic CT (no reference marks, curved CT couch surface, no immobilization devices), b same treatment plan calculated on the planning CT, which was acquired after the first fraction (rigid registration via isocenters; one vertebra was used as an anatomical reference structure for isocenter placement), c Dose difference map (cut off for doses < 10% of prescribed dose) with dose differences < 1% in the large central area
Fig. 4
Fig. 4
HU-rED calibration curves for different CT scanners from different vendors at our institution (120 kV abdominal protocol): red: Aquilion LB CT (Canon Medical Systems Corp., Otawara, JPN), blue: Discovery 690 PET-CT (GE Healthcare, Chalfont St Giles, GB), black: SOMATOM Definition AS (Siemens Healthineers, Erlangen, GER). Upper graph: HU-response curves and their mean, lower graph: deviations from the mean in absolute numbers
See this image and copyright information in PMC

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