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. 2021 Dec 14:21:1-7.
doi: 10.1016/j.tipsro.2021.11.006. eCollection 2022 Mar.

Two compound techniques for total body irradiation

Anders T Hansen  1 , Hanne K Rose  2 , Esben S Yates  1 , Jolanta Hansen  1 , Jørgen B B Petersen  1
Affiliations

Two compound techniques for total body irradiation

Anders T Hansen et al. Tech Innov Patient Support Radiat Oncol. .

Erratum in

Abstract

Introduction: Total body irradiation (TBI) is an important treatment modality that is used in combination with chemotherapy in many stem cell transplantation protocols. Therefore, the quality of the irradiation is important. Two techniques for planning and delivering TBI are presented and compared.

Methods and materials: The technique named ExIMRT is a combination of manually shaped conventional fields from an extended SSD and isocentric IMRT fields. The technique named ExVMAT is a combination of conventional and IMRT fields from an extended SSD and isocentric VMAT fields. Dosimetric data from 32 patients who were planned and treated according to one of the two techniques were compared.

Results: When comparing the two techniques, it is determined that the ExVMAT technique is able to significantly reduce the mean total volume overdosed by 120% from 408 to 12 cm3. The dose covering 98% of the total lung volume is significantly increased by this technique from a mean of 9.7 Gy to 10.3 Gy. Additionally, the dose covering 2% of the total kidney volume is significantly decreased from a mean of 12.8 to 12.5 Gy. Furthermore, the population-based variance of the median dose to the total lung volume, the heart and the volume of the body prescribed to 12.5 Gy is significantly reduced. The results are obtained without compromising overall treatment quality as treatment time or dose rate to the lungs.

Conclusion: Using the ExVMAT technique, a superior dose distribution can be delivered both from a patient and a population perspective compared to the ExIMRT technique.

Keywords: IMRT; RILI; Total body irradiation; Treatment planning; VMAT.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A selection of fields used for the ExVMAT technique including a setup field (A), a field with low energy (B), a field with high energy (C) and an IMRT field (D). The fluence map is illustrated in colour. Additionally, an example of the main field (E) and three forward planned field segments (F-H) from the treatment using the ExIMRT technique.
Fig. 2
Fig. 2
Illustration of the special volumes needed for the ExVMAT optimization. PTV thorax (A), PTV H (B) and PTV rest (C).
Fig. 3
Fig. 3
An overview of the iterative optimization process. Thin lines indicate the summation of plans. Thick lines indicate that the resulting plan is optimized based on the preceding plan. Dotted lines circumscribe the planes that constitute the result.
Fig. 4
Fig. 4
Mean DVHs for the analysed structures. For a given volume fraction, the mean, maximum and minimum doses for both techniques are displayed. A solid line and red colour for ExVMAT and dotted line and blue colour for ExIMRT.
See this image and copyright information in PMC

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