The Journal of Korean Society for Radiation Therapy (대한방사선치료학회지)

Korean Society for Radiation Therapy (대한방사선치료학회)
권호 표지

Usefulness assessment of the Volumetric Modulated Arc Therapy technique for reducing low-dose areas during radiotherapy for patients with multiple metastatic cancers

다발성 전이암 환자의 방사선치료 시 저선량 영역 감소를 위한 용적조절 회전 방사선치료(Volumetric Modulated Arc Therapy) 기법의 유용성 평가

  • Yun-won Choi (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Dong-min Jeong (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Se-young Kim (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Ryeong-hwang Park (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • I-ji Kim (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Yong-wan Cho (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Yongjae Kwon (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Byeol-nim Park (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Gyeong-min Yoo (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Ho-kyung Moon (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Dong-jae Jang (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Jae-young Lee (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Dayoung Lim (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Sang-gyu Lee (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center) ;
  • Jong-geol Baek (Department of Radiation Oncology, Yonsei University Yonsei Cancer Center)
  • 최윤원 (연세암병원 방사선종양학과) ;
  • 정동민 (연세암병원 방사선종양학과) ;
  • 김세영 (연세암병원 방사선종양학과) ;
  • 박령황 (연세암병원 방사선종양학과) ;
  • 김이지 (연세암병원 방사선종양학과) ;
  • 조용완 (연세암병원 방사선종양학과) ;
  • 권용재 (연세암병원 방사선종양학과) ;
  • 박별님 (연세암병원 방사선종양학과) ;
  • 유경민 (연세암병원 방사선종양학과) ;
  • 문호경 (연세암병원 방사선종양학과) ;
  • 장동재 (연세암병원 방사선종양학과) ;
  • 이재영 (연세암병원 방사선종양학과) ;
  • 임다영 (연세암병원 방사선종양학과) ;
  • 이상규 (연세암병원 방사선종양학과) ;
  • 백종걸 (연세암병원 방사선종양학과)
  • Published : 2023.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study is to evaluate the usefulness of Non-Treat Functionality Volumetric Modulated Arc Therapy(NTF-VMAT) and Treat Functionality VMAT(TF-VMAT) treatment plans in reducing the low-dose area during radiation therapy for patients with multiple metastatic cancers. Materials and Methods: The study was conducted on an Arccheck phantom, treatment planning target locations were set in pairs at intervals of 2 cm, 4 cm, and 6 cm on the X, Y, and Z axes. Based on these location settings, the volume of the low-dose area in NTF-VMAT and TF-VMAT was measured and compared. Results: The results of the study showed that, within a prescription dose range of 10% ~ 70%, the difference in low-dose area volumes across each axis was as follows: On the X-axis, there was a maximum difference of -47.6% and a minimum difference of -2.2%. On the Y-axis, there was a maximum difference of -17.5% and a minimum difference of -7.3%. The Z-axis showed a maximum difference of -39.7%, with the smallest difference being -6.8%. Conclusion: In radiation therapy for patients with multiple metastatic cancers, the TF-VMAT treatment plan was able to reduce the low-dose area by 10-40% compared to NTF-VMAT. This suggests that utilizing Treat Functionality, which includes the Island block technique, improves dose distribution and minimizes side effects, making it beneficial for the treatment of patients with multiple metastatic cancers.

목 적: 다발성 전이암 환자의 방사선치료 시 저선량 영역을 줄이기 위해 Non-Treat Functionailty-Volumetric Modulated Arc Therapy(NTF-VMAT)과 Treat Functionality VMAT(TF-VMAT)치료계획을 수립하고 비교하여 유용성을 평가하고자 한다. 대상 및 방법: Arccheck phantom에서 X, Y, Z 축에 2 cm, 4 cm, 6 cm 간격으로 치료계획용적 위치를 쌍(Pair)으로 설정하였다. 이를 바탕으로 NTF-VMAT와 TF-VMAT의 저선량 체적을 측정하여 비교·분석하였다. 결 과: 처방선량의 10% ~ 70% 범위 내에서 NTF-VMAT와 TF-VMAT의 18개 전산화 치료계획을 분석한 결과, 각 축에서 저선량 영역의 체적 차이는 X축에서는 최대 -47.6%, 최소 -2.2%, Y축에서는 최대 -17.5%, 최소 -7.3%의 차이가 나타났다. Z축에서는 최대 -39.7%의 차이를 보였으며, 가장 적은 차이는 -6.8%로 나타났다. 결 론: 다발성 전이암 환자의 방사선치료 시 TF-VMAT 치료계획이 NTF-VMAT에 비해 저선량 영역을 10~40% 줄일 수 있었다. 이는 Island block technique이 적용된 Treat Functionaliy을 이용하여 선량 분포를 개선하고, 부작용을 최소화하여 다발성 전이암 환자의 치료에 유용할 것으로 사료된다.

Keywords

References

  1. Ganesh K, Massague J : Targeting metastatic cancer. Nat Med.2021;27(1):34-44. https://doi.org/10.1038/s41591-020-01195-4
  2. Macedo F, Ladeira K, Pinho F, et al.: Bone Metastases: An Overview. Oncol Rev.2017;11(1):321.
  3. Biagioli MC, Harvey M, Roman E, et al.: Intensity-Modulated Radiotherapy With Concurrent hemotherapy for Previously Irradiated. Recurrent Head and Neck Cancer. Int J Radiat Oncol Biol Phys,2007;15;69(4):1067-73. https://doi.org/10.1016/j.ijrobp.2007.04.057
  4. Mark F, Alnsour A, Penfold SN, et al.: Volumetric modulated arc therapy (VMAT) comparison to 3Dconformal technique in lung stereotactic ablative radiotherapy (SABR).J Med Radiat Sci. 2023;70(1):72-80. https://doi.org/10.1002/jmrs.634
  5. Qi XS, Albuquerque K, Bailey S, et al.: Quality and Safety Considerations in Image Guided Radiation Therapy: An ASTRO Safety White Paper Update. Pract Radiat Oncol.2023;13(2):97-111. https://doi.org/10.1016/j.prro.2022.09.004
  6. Verbajek WFAR, Cuijpers JP, Hoffmans D, et al.:Volumetric Intensity-Modulated Arc Therapy Vs. Conventional IMRT in Head-and-Neck Cancer: A Comparative Planning and Dosimetric Study.Int J Radiat Oncol Biol Phys.2009;74(1):252-9. https://doi.org/10.1016/j.ijrobp.2008.12.033
  7. Pudsey LMM, Cutajar D, Wallace A, et al.: The use of collimator angle optimization and jaw tracking for VMAT-based single-isocenter multiple-target stereotactic radiosurgery for up to six targets in the Varian Eclipse treatment planning system,J Appl Clin Med Phys,2021;22(9):171-182. https://doi.org/10.1002/acm2.13360
  8. Shin DJ, Jung DM, Cho KC, et al.: The Study on the Effect of Target Volume in DQA based on MLC log file. The journal of the korean society for radiotherapeutic technology,2020;32(1):53-59.
  9. Thongsawad S, Srisatit S, Fuangrod T. Predicting gamma evaluation results of patient-specific head and neck volumetric-modulated arc therapy quality assurance based on multileaf collimator patterns and fluence map features: A feasibility study.J Appl Clin Med Phys,2022;23(7):e13622.
  10. Ezzell GA, Burmeister JW, Dogan N, et al.: IMRT commissioning: Multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119.Med Phys,2009;36(11):5359-5373. https://doi.org/10.1118/1.3238104
  11. Kataria T, Sharma K, Subramani V. et al.: Homogeneity Index: An objective tool for assessment of conformal radiation treatments.J Med Phys,2012;37(4):207-213. https://doi.org/10.4103/0971-6203.103606
  12. Menon SV, Paramu R, Bhasi S. et al.: Evaluation of Plan Quality Metrics in Stereotactic Radiosurgery/Radiotherapy in the Treatment Plans of Arteriovenous MalformationsJ Med Phys,2018;3(4):214-220.
  13. Gerstberger S, Jiang Q, Ganesh K. Review Metastasis.Cell,2023;186(8):1564-1579. https://doi.org/10.1016/j.cell.2023.03.003
  14. Brekey FJ : Managing the Adverse Effects of Radiation Therapy.Am Fam Physician,2010;82(4):381-388.