Dosimetric Comparison of Total Body Irradiation and Total Marrow Irradiation Using Volumetric Arc Therapy (VMAT)

Öz

It is aimed to compare target volume and critical organ doses using Volumeric arc therapy (VMAT) technique for Whole body irradiation (TVI) and Whole bone marrow irradiation (TKI). In the study, a random phantom with human tissue and organ densities was used.. VMAT plans were created with a daily fraction dose of 6 Gy and a total dose of 12 Gy. Target volumes and dose values received by critical organs were compared. Treatment plans The mean lung dose for VMAT-TVI is 7.6 Gy and the lens dose is 4.4 Gy, while organs at risk (OAR) doses for VMAT-TKI range from 2.7 to 7.15 Gy. In addition, pre-treatment quality control for both plans, dose accuracy between planned and administered doses using the Octavius 4D phantom, gamma index analysis with 3mm and 3% criteria in all 3 planes, we found that ≤1 for both treatment plans. We observed a very precise dose distribution between the planned and administered treatment. It was concluded that in both treatment techniques, the target volume received the desired dose, but in the VMAT-TBI technique, dose homogeneity and treatment application techniques should be improved. It was determined that other RAOs other than the lung were also better protected with TMI. As a result of our study, it was concluded that VMAT may be a suitable technique for both TBI and TMI application compared to traditional techniques in the future.

Anahtar Kelimeler

• Total body irradiation (TBI)
• Total marrow irradiation (TMI)
• Volumetric arc therapy (VMAT)
• Quality assurance (QA)

Volümetrik Ark Tedavi (VMAT) Tekniği Kullanarak Tüm Vücut Işınlaması ve Tüm Kemik İliği Işınlamasının Dozimetrik Karşılaştırılması

Öz

Bu araştırmada tüm vücut ışınlaması (TVI) ve tüm kemik iliği ışınlaması (TKI) için, Volümetrik Ark Tedavi (VMAT) tekniği kullanılarak, hedef hacim ve kritik organ dozlarının karşılaştırılması amaçlanmıştır. Çalışmada, insan doku ve organ yoğunluklarına sahip, rando fantom kullanıldı. VMAT planları günlük fraksiyon dozu 6 Gy olmak üzere toplam doz 12 Gy olacak şekilde, oluşturuldu. Hedef hacimler ve risk altındaki organların (RAO) aldığı doz değerleri karşılaştırıldı. VMAT-TVI için ortalama akciğer dozu, 7.6 Gy ve lens dozu 4.4 Gy iken, VMAT-TKI için, RAO’nun dozları 2.7 ila 7.15 Gy aralığındadır. Ayrıca her iki plan için tedavi öncesi kalite kontrolü Octavius 4D fantom kullanılarak, planlanan ve verilen dozlar arasında doz doğruluğu, her 3 düzlemde 3mm ve %3 kriterleri ile gama indeks analizi, her iki tedavi planı için ≤1 olduğu saptanmıştır. Planlanan ve uygulanan tedavi arasında oldukça hassas doz dağılımı olduğu gözlemlendi. Her iki tedavi tekniğinde de hedef volüm istenilen dozu aldığı, fakat VMAT-TVI tekniğinde, doz homojenliği ve tedavi uygulama tekniklerinin iyileştirilmesi gerektiği sonucuna varıldı. TKI ile akciğer dışındaki diğer RAO'ların da daha iyi korunabildiği saptandı. Çalışmamızın sonucunda, VMAT'ın gelecekte geleneksel tekniklere göre hem TVI hem de TKI uygulaması için uygun bir teknik olabileceği görüşüne varıldı.

Anahtar Kelimeler

• Tüm vücut ışınlaması (TVI)
• toplam kemik iliği ışınlaması (TKI)
• volümerik ark tedavisi (VMAT)
• kalite güvencesi (KG)

Kaynakça

1. 1. D’Souza A, Fretham C, Lee SJ, et al. Current use of and trends in hematopoietic cell transplantation in the United States. Biology of Blood and Marrow Transplantation 2020;26(8):177-82. doi:10.1016/J.BBMT.2020.04.013
2. 2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians 2018;68(6):394-424. doi:10.3322/caac.21492
3. 3. Halperin EC, Wazer DE, Perez CA, Brady LW. Perez and Brady’s principles and practice of radiation oncology. 6nd edition. Lippincott Williams & Wilkins; 2013 pp. 339-351.
4. 4. Khan FM. Khan’s the physics of radiation therapy. Fifth edition. Lippincott Williams & Wilkins/Wolters Kluwer; 2014. pp.405-412.
5. 5. Surucu M, Yeginer M, Kavak GO, Fan J, Radosevich JA, Aydogan B. Verification of dose distribution for volumetric modulated arc therapy total marrow irradiation in a humanlike phantom. Medical Physics. 2012;39(1):281-288. doi:10.1118/1.3668055
6. 6. Dyk J van, Galvin JM, Glasgow GP, Podgorsak EB. The physical aspects of total and half body photon irradiation a report of task group 29 radiation therapy committee amerıcan association of physicists in medicine The Physical Aspects of Total and Half Body Photon Irradiation. Published online 1986.
7. 7. Briot E, Dutreix A, Bridier A. Dosimetry for total body irradiation. Radiother Oncol. 1990;18(SUPPL. 1):16-29. doi:10.1016/0167-8140(90)90175-V
8. 8. Swangsilpa T, Kraiphibul P, Tangboonduangjit P, Tannanonta C, Layangkul T, Rattanasuwan O. In vivo whole body dosimetry measurement technique of total body ırradiation: A 12-year retrospective study result from one institute in Thailand. J Med Assoc Thai. 2011;94(6).

9. 9. Quast U. Whole body radiotherapy: A TBI-guideline. Journal of Medical Physics 2006;31(1):5-12. doi:10.4103/0971-6203.25664
10. 10. Buchali A, Feyer P, Groll J, Massenkeil G, Arnold R, Budach V. Immediate toxicity during fractionated total body irradiation as conditioning for bone marrow transplantation. Radiother Oncol 2000;54(2):157-162. doi:10.1016/S0167-8140(99)00178-4
11. 11. Leiper AD. Late effects of total body irradiation. Archives of Disease in Childhood. 1995;72(5):382. doi:10.1136/ADC.72.5.382
12. 12. Socié G, Salooja N, Cohen A, et al. Nonmalignant late effects after allogeneic stem cell transplantation. Blood 2003;101(9):3373-3385. doi:10.1182/BLOOD-2002-07-2231
13. 13. Curtis RE, Rowlings PA, Deeg HJ, et al. Solid cancers after bone marrow transplantation. N Engl J Med 1997;336(13):897-904. doi:10.1056/NEJM199703273361301
14. 14. Zhuang AH, Liu A, Schultheiss TE, Wong JYC. Dosimetric study and verification of total body irradiation using helical tomotherapy and its comparison to extended SSD Technique. Medical Dosimetry. 2010;35(4):243-249. doi:10.1016/J.MEDDOS.2009.07.001
15. 15. Chakraborty S, Cheruliyil S, Bharthan RK, Muttath G. Total Body Irradiation using VMAT (RapidArc): A planning study of a novel treatment delivery method: A planning study of a novel treat-ment delivery method Total body irradiation using VMAT (RapidArc): A planning study of a novel treatment delivery method. Article in International Journal of Cancer Therapy and Oncology 2015;3(2):13-16. doi:10.14319/ijcto.0302.8
16. 16. Quast U. Total body irradiation--review of treatment techniques in Europe. Radiother Oncol 1987;9(2):91-106. doi:10.1016/S0167-8140(87)80197-4
17. 17. Hui SK, Kapatoes J, Fowler J, et al. Feasibility study of helical tomotherapy for total body or total marrow irradiationa). Medical Physics 2005;32(10):3214-3224. doi:10.1118/1.2044428
18. 18. Hui SK, Verneris MR, Higgins P, et al. Helical tomotherapy targeting total bone marrow - first clinical experience at the University of Minnesota. Acta Oncol. 2007;46(2):250-255. doi:10.1080/02841860601042449
19. 19. Wong JYC, Rosenthal J, Liu A, et al. 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(1):273-279. doi:10.1016/J.IJROBP.2008.04.071
20. 20. 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(12):5609-5618. doi:10.1118/1.2990779
21. 21. Aydogan B, Mundt AJ, Roeske JC. Linac-based intensity modulated total marrow irradiation (IM-TMI). Technology in Cancer Research and Treatment 2006;5(5):513-519. doi:10.1177/153303460600500508
22. 22. Yeginer M, Roeske JC, Radosevich JA, Aydogan B. Linear accelerator-based intensity-modulated total marrow irradiation technique for treatment of hematologic malignancies: A dosimetric feasibility study. Int J Radiat Oncol Biol Phys. 2011;79(4):1256-1265. doi:10.1016/J.IJROBP.2010.06.029
23. 23. Otto K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Medical Physics. 2008;35(1):310-317. doi:10.1118/1.2818738
24. 24. Fogliata A, Cozzi L, Clivio A, et al. Preclinical Assessment of Volumetric Modulated Arc Therapy for Total Marrow Irradiation. International Journal of Radiation Oncology*Biology*Physics 2011;80(2):628-636. doi:10.1016/J.IJROBP.2010.11.028
25. 25. Aydogan B, Yeginer M, Kavak GO, et al. Total marrow irradiation with rapidarc volumetric arc therapy. International Journal of Radiation Oncology, Biology, Physics 2011;81(2):592-599. doi:10.1016/J.IJROBP.2010.11.035
26. 26. Han C, Schultheisss TE, Wong JYC. Dosimetric study of volumetric modulated arc therapy fields for total marrow irradiation. Radiother Oncol. 2012;102(2):315-320. doi:10.1016/J.RADONC.2011.06.005
27. 27. Mancuso GM, Fontenot JD, Gibbons JP, Parker BC. Comparison of action levels for patient-specific quality assurance of intensity modulated radiation therapy and volumetric modulated arc therapy treatments. Med Phys. 2012;39(7):4378-4385. doi:10.1118/1.4729738
28. 28. Özdemir Ö, Hoca S, Olacak N, Özkök S, Kamer S, Anacak Y. Tüm vücut ışınlamalarında orta hat dozlarının belirlenmesi ve hesaplanan dozların doğrulanması Midplane dose determination and verification of calculated doses in total body irradiation. Türk Onkoloji Dergisi 2013;28(2):67-74. doi:10.5505/tjoncol.2013.898
29. 29. Tas B, Durmus IF, Okumus A, et al. Total-body irradiation using linac-based volumetric modulated arc therapy: Its clinical accuracy, feasibility and reliability. Radiother Oncol. 2018;129(3):527-533. doi:10.1016/J.RADONC.2018.08.005
30. 30. Harris AC, Kitko CL, Couriel DR, et al. Extramedullary relapse of acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation: incidence, risk factors and outcomes. Haematologica 2013;98(2):179-184. doi:10.3324/HAEMATOL.2012.073189
31. 31. Mortimer J, Blinder MA, Schulman S, et al. Relapse of acute leukemia after marrow transplantation: natural history and results of subsequent therapy. J Clin Oncol. 1989;7(1):50-57. doi:10.1200/JCO.1989.7.1.50
32. 32. Chong G, Byrnes G, Szer J, Grigg A. Extramedullary relapse after allogeneic bone marrow transplantation for haematological malignancy. Bone Marrow Transplant. 2000;26(9):1011-1015. doi:10.1038/SJ.BMT.1702659
33. 33. Lee KH, Lee JH, Choi SJ, et al. Bone marrow vs extramedullary relapse of acute leukemia after allogeneic hematopoietic cell transplantation: risk factors and clinical course. Bone Marrow Transplant. 2003;32(8):835-842. doi:10.1038/SJ.BMT.1704223
34. 34. Solh M, DeFor TE, Weisdorf DJ, Kaufman DS. Extramedullary relapse of acute myelogenous leukemia after allogeneic hematopoietic stem cell transplantation: better prognosis than systemic relapse. Biol Blood Marrow Transplant. 2012;18(1):106-112. doi:10.1016/J.BBMT.2011.05.023