In-vivo dosimetry with Gafchromic films for multi-isocentric VMAT irradiation of total marrow lymph-nodes: a feasibility study

Radiation Oncology

Marta Scorsetti¹  Stefano Tomatis¹  Luca Castagna²  Antonella Stravato¹  Barbara Sarina²  Valentina Palumbo¹  Lucia Paganini¹  Francesca Lobefalo¹  Anna Gaudino¹  Antonella Fogliata¹  Luca Cozzi¹  Giacomo Reggiori¹  Pierina Navarria¹  Pietro Mancosu¹ 

[1] Radiation Oncology Department, Humanitas Clinical and Research Center, Milan, Rozzano, Italy;Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Milan, Rozzano, Italy

关键词: Radiotherapy;    Plan optimization;    GafChromics;    Bone transplantation;    In vivo dosimetry;    Total marrow irradiation;   

Others  :  1177389
DOI  :  10.1186/s13014-015-0391-y

 received in 2014-10-17, accepted in 2015-03-17,  发布年份 2015

【 摘 要 】

Background

Total marrow (lymph-nodes) irradiation (TMI-TMLI) by volumetric modulated arc therapy (VMAT) was shown to be feasible by dosimetric feasibility studies. It was demonstrated that several partially overlapping arcs with different isocenters are required to achieve the desired coverage of the hematopoietic or lymphoid tissues targets and to spare the neighbouring healthy tissues. The effect of isocenter shifts was investigated with the treatment planning system but an in- vivo verification of the procedure was not carried out. The objective of this study was the in-vivo verification of the consistency between the delivered and planned doses using bi-dimensional GafChromic EBT3 films.

Methods

In a first phase a phantom study was carried out to quantify the uncertainties under controlled conditions. In a second phase three patients treated with TMLI were enrolled for in-vivo dosimetry. The dose prescription was 2Gy in single fraction. Ten arcs paired on 4-6 isocenters were used to cover the target. Cone Beam Computed Tomography (CBCT) was used to verify the patient positioning at each isocenter. GafChromic EBT3 films were placed below the patient on the top of a dedicated immobilization system specifically designed. The dose maps measured with the EBT3 films were compared with the corresponding calculations along the patient support couch. Gamma Agreement Index (GAI) with dose difference of 5% and distance to agreement of 5 mm was computed.

Results

In the phantom study, optimal target coverage and healthy tissue sparing was observed. GAI(5%,5 mm) was 99.4%. For the patient-specific measurements, GAI(5%,5 mm) was greater than 95% and GAI (5%,3 mm) > 90% for all patients.

Conclusions

In vivo measurements demonstrated the delivered dose to be in good agreement with the planned one for the TMI-TMLI protocol where partially overlapping arcs with different isocenters are required.

【 授权许可】

   
2015 Mancosu et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Bieri S, Helg C, Chapuis B, Miralbell R. Total body irradiation before allogenic bone marrow transplantation: is more dose better? Int J radiat Oncol Biol Phys. 2001; 49:1071-7.
• [2]Clif RA, Buckner CD, Appelbaum FA, Bryant E, Bearman SI, Petersen FB et al.. Allogenic marrow transplantation in patients with chronic myeloid-leukemia in the chronic phase – a randomized trial of 2 irradiation regiments. Blood. 1991; 77:1660-5.
• [3]Kim JH, Stein A, Tsai N, Schultheiss TE, Palmer J, Liu A et al.. Extramedullary relapse following total marrow and lymphoid irradiation in patients undergoing allogeneic hematopoietic cell transplantation. Int J Radiat Oncol Biol Phys. 2014; 89(1):75-81.
• [4]Wilkie JR, Tiryaki H, Smith BD, Roeske JC, Radosevich JA, Aydogan B. Feasibility study for linac-based intensity modulated total marrow irradiation. Med Phys. 2008; 35:5609-18.
• [5]Aydogan B, Mundt A, Roeske JC. Linac-based intensity modulated total marrow irradiation (IM-TMI). Technol Cancer Res Treat. 2006; 5:513-9.
• [6]Hui SK, Kapatoes J, Fowler J, Henderson D, Olivera G, Manon RR et al.. Feasibility study of helical tomotherapy for total body or total marrow irradiation. Med Phys. 2005; 32:3214-24.
• [7]Wong JY, Rosenthal J, Liu A, Schultheiss T, Forman S, Somlo G. Image-guided total- marrow irradiation using helical tomotherapy in patients with multiple myeloma and acute leukemia undergoing hematopoietic cell transplantation. Int J Radiat Oncol Biol Phys. 2009; 73:273-9.
• [8]Fogliata A, Cozzi L, Clivio A, Ibatici A, Mancosu P, Navarria P et al.. Preclinical assessment of volumetric modulated arc therapy for total marrow irradiation. Int J Radiat Oncol Biol Phys. 2011; 80:628-36.
• [9]Mancosu P, Navarria P, Castagna L, Roggio A, Pellegrini C, Reggiori G et al.. Anatomy driven optimisation strategy for total marrow irradiation with a volumetric modulated arc therapy technique. J Appl Clin Med Phys. 2012; 13:3653.
• [10]Aydogan B, Yeginer M, Kavak GO, Fan J, Radosevich JA, Gwe-Ya K. Total Marrow Irradiation with RapidArc Volumetric Arc Therapy. Int J Radiat Oncol Biol Phys. 2011; 81:592-9.
• [11]Han C, Schultheiss TE, Wong JY. Dosimetric study of volumetric modulated arc therapy fields for total marrow irradiation. Radiother Oncol. 2011; 112:315-20.
• [12]Sorucu M, Yeginer M, Kaval O, Radosevich JA, Aydogan B. Verification of dose distribution for volumetric modulated arc therapy total marrow irradiation in a humanlike phantom. Med Phys. 2012; 39:281-8.
• [13]Mancosu P, Navarria P, Castagna L, Reggiori G, Sarina B, Tomatis S et al.. Interplay effects between dose distribution quality and positioning accuracy in total marrow irradiation with volumetric modulated arc therapy. Med Phys. 2013; 40(11):111713.
• [14]Bornhäuser M, Kienast J, Trenschel R, Burchert A, Hegenbart U, Stadler M et al.. Reduced-intensity conditioning versus standard conditioning before allogeneic haemopoietic cell transplantation in patients with acute myeloid leukaemia in first complete remission: a prospective, open-label randomised phase 3 trial. Lancet Oncol. 2012; 13(10):1035-44.
• [15]Storb RF, Champlin R, Riddell SR, Murata M, Bryant S, Warren EH. Non-myeloablative transplants for malignant disease. Hematology Am Soc Hematol Educ Program. 2001; 1:375-91.
• [16]Baron F, Storb R, Storer BE, Maris MB, Niederwieser D, Shizuru JA et al.. Factors associated with outcomes in allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning after failed myeloablative hematopoietic cell transplantation. J Clin Oncol. 2006; 24(25):4150-7.
• [17]Shimohigashi Y, Araki F, Tominaga H, Sakata J, Kawasaki K, Kanetake N et al.. Angular dependence correction of MatriXX and its application to composite dose verification. J Appl Clin Med Phys. 2012; 13(5):3856.
• [18]Fogliata A, Clivio A, Fenoglietto P, Hrbacek J, Kloeck S, Lattuada P et al.. Quality assurance of RapidArc in clinical practice using portal dosimetry. Br J Radiol. 2011; 84(1002):534-45.
• [19]Mijnheer B, Beddar S, Izewska J, Reft C. In vivo dosimetry in external beam radiotherapy. Med Phys. 2013; 40(7):070903.
• [20]Ganapathy K, Kurup PGG, Murali V, Muthukumaran M, Bhuvaneshwari N, Velmurugan J. Patient dose analysis in total body irradiation through in vivo dosimetry. J. Med. Phys. 2012; 37:214-8.
• [21]Yao R, Bernard D, Turian J, Abrams RA, Sensakovic W, Fung HC et al.. A simplified technique for delivering total body irradiation (TBI) with improved dose homogeneity. Med. Phys. 2012; 39:2239.
• [22]Akino Y, McMullen JP, Das IJ. Patterns of patient specific dosimetry in total body irradiation. Med Phys. 2013; 40:041719.
• [23]Fiandra C, Ricardi U, Ragona R, Anglesio S, Giglioli FR, Calamia E et al.. Clinical use of EBT model Gafchromic film in radiotherapy. Med Phys. 2006; 33:4314-9.
• [24]Ganapathy K, Kurup PGG, Murali V, Muthukumaran M, Balaji Subramanian S, Velmurugan J. A study on rectal dose measurement in phantom and in vivo using Gafchromic EBT3 film in IMRT and CyberKnife treatments of carcinoma of prostate. J. Med. Phys. 2013; 38:132-8.
• [25]Kim S, Yoo S, Yin FF, Samei E, Yoshizumi T. Kilovoltage cone-beam CT: comparativedose and image quality evaluations in partial and full-angle scan protocols. Med Phys. 2010; 37(7):3648-59.
• [26]Low DA, Harms WB, Mutic S, Purdy JA. A technique for quantitative evaluation of dose distributions. Med Phys. 1998; 25:656-6.