A dosimetric study of intensity modulated radiotherapy, volumetric modulated arc therapy for hyperthyroidism exophthalmus patients using flattening filter free or flattening filter modes_West China Medical Journal

Authors：

LAI Jialu , LIU Shoupeng , ZHANG Qin , BAI Sen ,  ZHONG Renming

Department of Radiotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHONG Renming, Email: zrm_100@163.com

Keywords：

Hyperthyroidism exophthalmus; Flatting filter; Flatting filter free; Intensity modulated radiotherapy; Volumetric modulated arc therapy

DOI：

10.7507/1002-0179.201810017

Video：

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Objective To compare the dosimetric differences among flattening filter free intensity modulated radiotherapy (3FIMRT), flattening filter free volumetric modulated arc therapy (3FVMAT), filter free intensity modulated radiotherapy (IMRT), and filter free volumetric modulated arc therapy (VMAT) for hyperthyroidism exophthalmus patients.Methods Computed tomography (CT) scans of 29 patients, who were diagnosed with hyperthyroidism exophthalmus and treated with radiation therapy between September 2016 and September 2017, were selected for study. Four treatment plans with the same dose prescription and objective constrains were designed for each patient based on their images, consisting of IMRT, VMAT, 3FIMRT, and 3FVMAT. The target dosimetric distribution, normal tissue radiation dose, monitor units, and treatment time of each plan were evaluated.Results Four types of plans were all able to satisfy the clinical treatment requirements, and there were no significant differences in maximum dose, mean dose (D_mean), homogeneity index of the targets (P>0.05). For the parameters minimum dose, V_50%, conformity index (CI), gradient index of the targets, statistically significant differences were observed among the four kinds of technologies (F=10.920, 35.860, 11.320, 17.790; P<0.05). The CI of IMRT and 3FIMRT were superior to those of VMAT and 3FVMAT, but there was no significant difference between IMRT and 3FIMRT. In terms of Lens D_mean and Brain D_mean, statistically significant differences were observed among the four kinds of technologies (F=5.054, 83.780; P<0.05). For Lens D_mean and Brain D_mean, 3FVMAT achieved better sparing effects when compared with the other three plans. The total monitor units and treatment time did not significantly differ between 3FVMAT and VMAT. The mean monitor units of 3FVMAT were 65.07% and 70.22% less than that of IMRT and 3FIMRT respectively. The mean treatment time of 3FVMAT were 48.1% and 35.24% less than that of IMRT and 3FIMRT respectively.Conclusion 3FVMAT can bring more dosimetric advantages for hyperthyroidism exophthalmus radiation therapy when compared with IMRT, 3FIMRT, and VMAT.

Citation： LAI Jialu, LIU Shoupeng, ZHANG Qin, BAI Sen, ZHONG Renming. A dosimetric study of intensity modulated radiotherapy, volumetric modulated arc therapy for hyperthyroidism exophthalmus patients using flattening filter free or flattening filter modes. West China Medical Journal, 2019, 34(2): 172-178. doi: 10.7507/1002-0179.201810017 Copy

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2.	贺丹, 付波. Graves 眼病放射治疗三种不同照射技术的剂量学研究. 华西医学, 2016, 31(12): 2000-2003.
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5.	Stathakis S, Esquivel C, Gutierrez AA, et al. Treatment planning and delivery of IMRT using 6 and 18 MV photon beams without flattening filter. Appl Radiat Isot, 2009, 67(9): 1629-1637.
6.	贾飞, 岳海振, 李国文, 等. 有无均整器模式下鼻咽癌容积旋转调强放疗计划的剂量学比较. 中华放射医学与防护杂志, 2014, 34(8): 597-600.
7.	Fu WH, Dai JR, Hu YM, et al. Delivery time comparison for intensity-modulated radiation therapy with/without flattening filter: a planning study. Phys Med Biol, 2004, 49(8): 1535-1547.
8.	Zwahlen DR, Lang S, Hrbacek J, et al. The use of photon beams of a flattening filter-free linear accelerator for hypofractionated volumetric modulated arc therapy in localized prostate cancer. Int J Radiat Oncol Biol Phys, 2012, 83(5): 1655-1660.
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11.	Chung H, Jin H, Palta J, et al. Dose variations with varying calculation grid size in head and neck IMRT. Phys Med Biol, 2006, 51(19): 4841-4856.
12.	乌晓礼, 王利华, 郁志龙, 等. Pinnacle3 治疗计划系统中计算网格大小对剂量分布的比较研究. 中华放射肿瘤学杂志, 2014, 23(3): 224-225.
13.	Baltas D, Kolotas C, Geramani K, et al. A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy. Int J Radiat Oncol Biol Phys, 1998, 40(2): 515-524.
14.	Wu Q, Mohan R, Morris M, et al. Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results. Int J Radiat Oncol Biol Phys, 2003, 56(2): 573-585.
15.	Paddick I, Lippitz B. A simple dose gradient measurement tool to complement the conformity index. J Neurosurg, 2006, 105(Suppl 1): 194-201.
16.	Hodaapp N. The ICRU 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlenther Onkol, 2012, 188(1): 97-99.
17.	Fenkell L, Kaminsky I, Breen S, et al. Dosimetric comparison of IMRT vs. 3D conformal radiotherapy in the treatment of cancer of the cervical esophagus. Radiother Oncol, 2008, 89(3): 287-291.
18.	Mcgrath SD, Matuszak MM, Yan D, et al. Volumetric modulated arc therapy for delivery of hypofractionated stereotactic lung radiotherapy: a dosimetric and treatment efficiency analysis. Radiother Oncol, 2010, 95(2): 153-157.
19.	Scorsetti M, Alongi F, Castiglioni S, et al. Feasibility and early clinical assessment of flattening filter free (FFF) based stereotactic body radiotherapy (SBRT) treatments. Radiat Oncol, 2011, 6(1): 113.
20.	单改仙, 任晔, 王莹, 等. Graves 眼病 3D-CRT、IMRT 和 VMAT 放疗剂量分布比较. 实用医药杂志, 2017, 34(12): 1079-1082.
21.	Guckenberger M, Richter A, Krieger T, et al. Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes?. Radiother Oncol, 2009, 93(2): 259-265.
22.	Nicolini G, Ghosh-Laskar S, Shrivastava SK, et al. Volumetric modulation arc radiotherapy with flattening filter-free beams compared with static gantry IMRT and 3D conformal radiotherapy for advanced esophageal cancer: a feasibility study. Int J Radiat Oncol Biol Phys, 2012, 84(2): 553-560.

1. 金珂, 朱豫. 甲状腺相关眼病患者干眼症患病率及特征分析. 眼科新进展, 2015, 35(5): 473-475.
2. 贺丹, 付波. Graves 眼病放射治疗三种不同照射技术的剂量学研究. 华西医学, 2016, 31(12): 2000-2003.
3. Bartalena L, Baldeschi L, Dickinson AJ, et al. Consensus statement of the European Group on Graves’ or Bitopathy (EUGOGO) on management of Graves’ or bitopathy. Thyroid, 2008, 18(3): 333-346.
4. 廖熊飞, 李厨荣, 李宁山, 等. 自动和逆向 3DCRT 与逆向 IMRT 计划剂量学比较. 中华放射肿瘤学杂志, 2017, 26(4): 437-441.
5. Stathakis S, Esquivel C, Gutierrez AA, et al. Treatment planning and delivery of IMRT using 6 and 18 MV photon beams without flattening filter. Appl Radiat Isot, 2009, 67(9): 1629-1637.
6. 贾飞, 岳海振, 李国文, 等. 有无均整器模式下鼻咽癌容积旋转调强放疗计划的剂量学比较. 中华放射医学与防护杂志, 2014, 34(8): 597-600.
7. Fu WH, Dai JR, Hu YM, et al. Delivery time comparison for intensity-modulated radiation therapy with/without flattening filter: a planning study. Phys Med Biol, 2004, 49(8): 1535-1547.
8. Zwahlen DR, Lang S, Hrbacek J, et al. The use of photon beams of a flattening filter-free linear accelerator for hypofractionated volumetric modulated arc therapy in localized prostate cancer. Int J Radiat Oncol Biol Phys, 2012, 83(5): 1655-1660.
9. Chae SM, Lee GW, Son SH. The effect of multileaf collimator leaf width on the radiosurgery planning for spine lesion treatment in terms of the modulated techniques and target complexity. Radiati Oncol, 2014, 9(1): 72-81.
10. 王文婷, 李勤, 梁志文, 等. 计算网格改变对鼻咽癌调强放疗计算精度的影响. 中华放射肿瘤学杂志, 2009, 18(6): 494-495.
11. Chung H, Jin H, Palta J, et al. Dose variations with varying calculation grid size in head and neck IMRT. Phys Med Biol, 2006, 51(19): 4841-4856.
12. 乌晓礼, 王利华, 郁志龙, 等. Pinnacle3 治疗计划系统中计算网格大小对剂量分布的比较研究. 中华放射肿瘤学杂志, 2014, 23(3): 224-225.
13. Baltas D, Kolotas C, Geramani K, et al. A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy. Int J Radiat Oncol Biol Phys, 1998, 40(2): 515-524.
14. Wu Q, Mohan R, Morris M, et al. Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results. Int J Radiat Oncol Biol Phys, 2003, 56(2): 573-585.
15. Paddick I, Lippitz B. A simple dose gradient measurement tool to complement the conformity index. J Neurosurg, 2006, 105(Suppl 1): 194-201.
16. Hodaapp N. The ICRU 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlenther Onkol, 2012, 188(1): 97-99.
17. Fenkell L, Kaminsky I, Breen S, et al. Dosimetric comparison of IMRT vs. 3D conformal radiotherapy in the treatment of cancer of the cervical esophagus. Radiother Oncol, 2008, 89(3): 287-291.
18. Mcgrath SD, Matuszak MM, Yan D, et al. Volumetric modulated arc therapy for delivery of hypofractionated stereotactic lung radiotherapy: a dosimetric and treatment efficiency analysis. Radiother Oncol, 2010, 95(2): 153-157.
19. Scorsetti M, Alongi F, Castiglioni S, et al. Feasibility and early clinical assessment of flattening filter free (FFF) based stereotactic body radiotherapy (SBRT) treatments. Radiat Oncol, 2011, 6(1): 113.
20. 单改仙, 任晔, 王莹, 等. Graves 眼病 3D-CRT、IMRT 和 VMAT 放疗剂量分布比较. 实用医药杂志, 2017, 34(12): 1079-1082.
21. Guckenberger M, Richter A, Krieger T, et al. Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes?. Radiother Oncol, 2009, 93(2): 259-265.
22. Nicolini G, Ghosh-Laskar S, Shrivastava SK, et al. Volumetric modulation arc radiotherapy with flattening filter-free beams compared with static gantry IMRT and 3D conformal radiotherapy for advanced esophageal cancer: a feasibility study. Int J Radiat Oncol Biol Phys, 2012, 84(2): 553-560.

West China Medical Journal

A dosimetric study of intensity modulated radiotherapy, volumetric modulated arc therapy for hyperthyroidism exophthalmus patients using flattening filter free or flattening filter modes

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