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. 2023 Jun 6:27:100456.
doi: 10.1016/j.phro.2023.100456. eCollection 2023 Jul.

Palliative intensity modulated radiotherapy of bone metastases based on diagnostic instead of planning computed tomography scans

Suvi Larjavaara  1 , Satu Strengell  1 , Tiina Seppälä  1 , Mikko Tenhunen  1 , Anu Anttonen  1
Affiliations

Palliative intensity modulated radiotherapy of bone metastases based on diagnostic instead of planning computed tomography scans

Suvi Larjavaara et al. Phys Imaging Radiat Oncol. .

Abstract

Background and purpose: Radiotherapy (RT) treatment planning is as a standard based on a computed tomography (CT) scan obtained at the planning stage (pCT), while most of the decisions whether to treat by RT are based on diagnostic CT scans (dCT). Bone metastases (BM) are the most common palliative RT target. The objective of this study was to investigate if a palliative RT treatment plan of BMs could be made based on a dCT with sufficient accuracy and safety, without sacrificing any treatment quality.

Materials and methods: A retrospective study with 60 BMs of 8 anatomical sites was performed. RT planning was performed using intensity-modulated radiation therapy/volumetric modulated arc therapy techniques in dCT and transferred to pCT. The dose of clinical target volumes (CTVs), D(CTVV95%, V50%), were compared between plans for dCT and pCT. Patient setup was investigated in cone-beam CT scans.

Results: The differences of D(CTVV95%, V50%) between dCT and pCT plans were the lowest in the pelvis (1.0%, 1.1%), lumbar spine (0.6%, 0.7%) and thoracic spine (0.7%, 2.1%), while the differences were higher in cervical spine (3.7%, 1.9%), long bones (2.3%, 0.8%), and costae (1.6%, 1.4%). The patient set-up was acceptable for 100% of the pelvic and lumbar, for 92% of thoracic spine cases, and for <80% of cases in other sites.

Conclusion: This study showed the feasibility of using dCT images in palliative RT planning of BMs in thoracic, lumbar spine and pelvic sites, indicating the potential suitability of this strategy for clinical use.

Keywords: Computer-assisted; Neoplasm metastasis; Palliative care; Radiotherapy planning; Radiotherapy setup errors.

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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
Median dose difference with ranges between plans calculated for diagnostic CT (dCT) images and planning CT (pCT) images shown as a) 50% and b) 95% volume of CTV.
Fig. 2
Fig. 2
Median dose difference between plans of diagnostic CT images and planning CT images shown in mean volume of healthy tissue.
See this image and copyright information in PMC

References

    1. International Atomic Energy Agency. Radiotherapy in Palliative Cancer Care: Development and Implementation. IAEA Human Health Reports No. 2, 2012. IAEA, Vienna.
    1. Hernandez R.K., Wade S.W., Reich A., Pirolli M., Liede A., Lyman G.H. Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States. BMC Cancer. 2018;18:44. - PMC - PubMed
    1. Ryan C., Stoltzfus K.C., Horn S., Chen H., Louie A.V., Lehrer E.J., et al. Epidemiology of bone metastases. Bone. 2022;158 doi: 10.1016/j.bone.2020.115783. - DOI - PubMed
    1. Lutz S., Balboni T., Jones J., Lo S., Petit J., Rich S.E., et al. Palliative radiation therapy for bone metastases: update of an ASTRO evidence-based guideline. Pract Radiat Oncol. 2017;7:4–12. doi: 10.1016/j.prro.2016.08.001. - DOI - PubMed
    1. Wong S., Roderick S., Kejda A., Atyeo J., Grimberg K., Porter B., et al. Diagnostic computed tomography enabled planning for palliative radiation therapy: removing the need for a planning computed tomography scan. Pract Radiat Oncol. 2021;11:e146–e153. doi: 10.1016/j.prro.2020.10.010. - DOI - PubMed

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