Optimization of beam sets and segments number in static intensity-modulated radiation therapy plans in radiotherapy of gastric cancer_West China Medical Journal

Authors：

LI Xia ¹ , WANG Xuetao ¹ , LI Tao ¹ , ZHAO Yaqin ² , LI Zhiping ² , BAI Sen ¹ ,  SHEN Yali ²

1. Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Abdominal Oncology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SHEN Yali, Email: sylprecious@163.com

Keywords：

Gastric cancer; Static intensity-modulated radiation therapy; Beams sets; Segments number; Plan quality; Treatment time

DOI：

10.7507/1002-0179.201712152

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ObjectiveTo compare the static intensity-modulated radiation therapy (IMRT) plans using different beams sets and segments number, and find the better static IMRT plan sets on beams and segments in gastric surgical adjuvant radiotherapy.MethodsFifteen patients who underwent adjuvant radiotherapy for gastric cancer between February 1st and August 30th, 2013 were chosen as subjects through random sampling. Based on the 5 beams static IMRT plans already used in clinical practice, four different static IMRT plans used diverse beams sets for each patient were designed in the same treatment planning system (Pinnacle 9.2). The beams sets of static IMRT plans were as follows: 7 coplanar equal beams; 5 coplanar equal beams; 4 coplanar beams of 310, 20, 90 and 180°; 3 coplanar beams of 310, 65 and 180°. Sufficient segments 65 was set as the max segments number in order to compare the plans’ difference just resulting from beams. In the second step, the max segments number was changed from 65 to 45 and 25 to design two different static IMRT plans for the 4 coplanar beams static IMRT plans. The dosimetric parameters were compared for the planning target volume (PTV) and organs at risk (OARs). The monitor units and treatment times of the different static IMRT plans were also evaluated.ResultsWhen the max segments number was set to 65, the 4 coplanar beams static IMRT plans were a little better on PTV conformability than the 5 coplanar beams static IMRT plans used in clinical practice (0.74±0.04 vs. 0.73±0.05, P<0.01). Meanwhile, better OARs dose sparing especially for liver and kidneys were gained by the 4 coplanar beams static IMRT plans, for example, the percent volume gained 30 Gy for liver [(22.71±6.10)%vs. (24.03±6.84)%, P<0.01] and the percent volume gained 20 Gy for the right kidney [(14.97±6.72)%vs. (19.41±6.14)%, P<0.01]. The PTV conformability of the 4 coplanar beams static IMRT plans reduced as the max segments number became smaller (0.74±0.04vs. 0.73±0.04 vs. 0.71±0.04, P<0.05). However, they were still acceptable in clinical practice. And the better dose sparing for liver and kidneys were retained. The average reductions of 1.8 and 4.3 minutes on the irradiation time were get by the 4 coplanar beams static IMRT plans with the max segments number 45 and 25 compared to that with the max segments number 65 [(494.66±26.79)vs. (384.26±14.99) vs. (235.00±9.21) s, P<0.01]. And the raises of treatment efficiency were 22.3% and 52.4%, respectively (P<0.05).ConclusionsThe 4 coplanar beams static IMRT plans with fewer segments could ensure plan quality, and protect the OARs better in the meanwhile, especially for liver and kidneys. The treatment time is reduced as well. The 4 coplanar beams static IMRT plans could improve the treatment efficiency.

Citation： LI Xia, WANG Xuetao, LI Tao, ZHAO Yaqin, LI Zhiping, BAI Sen, SHEN Yali. Optimization of beam sets and segments number in static intensity-modulated radiation therapy plans in radiotherapy of gastric cancer. West China Medical Journal, 2018, 33(4): 403-410. doi: 10.7507/1002-0179.201712152 Copy

1.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2.	Sasako M, Sano T, Yamamoto S, et al. D₂ lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med, 2008, 359(5): 453-462.
3.	Lim DH, Kim DY, Kang MK, et al. Patterns of failure in gastric carcinoma after D₂ gastrectomy and chemoradiotherapy: a radiation oncologist's view. Br J Cancer, 2004, 91(1): 11-17.
4.	Yoo CH, Noh SH, Shin DW, et al. Recurrence following curative resection for gastric carcinoma. Br J Surg, 2000, 87(2): 236-242.
5.	Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med, 2001, 345(10): 725-730.
6.	Park SH, Sohn TS, Lee J, et al. Phase Ⅲ trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses. J Clin Oncol, 2015, 33(28): 3130-3136.
7.	Alani S, Soyfer V, Strauss N, et al. Limited advantages of intensity-modulated radiotherapy over 3D conformal radiation therapy in the adjuvant management of gastric cancer. Int J Radiat Oncol Biol Phys, 2009, 74(2): 562-566.
8.	Milano MT, Garofalo MC, Chmura SJ, et al. Intensity-modulated radiation therapy in the treatment of gastric cancer: early clinical outcome and dosimetric comparison with conventional techniques. Br J Radiol, 2006, 79(942): 497-503.
9.	Hoogeman MS, Nuyttens JJ, Levendag PC, et al. Time dependence of intrafraction patient motion assessed by repeat stereoscopic imaging. Int J Radiat Oncol Biol Phys, 2008, 70(2): 609-618.
10.	Teoh M, Clark CH, Wood K, et al. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol, 2011, 84(17): 967-996.
11.	Edge SB, Compton CC. The American joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
12.	Hess CF, Christ G, Jany R, et al. Dosage specification at the ICRU reference point: the consequences for clinical practice. Strahlenther Onkol, 1993, 169(11): 660-667.
13.	Wambersie A, Landberg T, Prescribing GR. Recording and reporting photon beam therapy: the problem of margins (the recent ICRU recommendations, Report 62, 1999). Patras Medical Physics, 1999, 99(1): 25-31.
14.	Smalley SR, Gunderson L, Tepper J, et al. Gastric surgical adjuvant radiotherapy consensus report: rationale and treatment implementation. Int J Radiat Oncol Biol Phys, 2002, 52(2): 283-293.
15.	Tepper JE, Gunderson LL. Radiation treatment parameters in the adjuvant postoperative therapy of gastric cancer. Semin Radiat Oncol, 2002, 12(2): 187-195.
16.	Daly-Schveitzer N, Julieron M, Tao YG, et al. Intensity-modulated radiation therapy (IMRT): toward a new standard for radiation therapy of head and neck cancer?. Eur Ann Otorhinolaryngol Head Neck Dis, 2011, 128(5): 241-247.
17.	Gomez-Millan J, Fernandez JR, Medina CJ. Current status of IMRT in head and neck cancer. Reports of practical oncology and radiotherapy. Rep Pract Oncol Radiother, 2013, 18(6): 371-375.
18.	Arbea L, Ramos L, Martinez-Monge R, et al. Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications. Radiat Oncol, 2010, 5: 17.
19.	Chung HT, Lee B, Park E, et al. Can all centers plan intensity-modulated radiotherapy (IMRT) effectively? An external audit of dosimetric comparisons between three-dimensional conformal radiotherapy and IMRT for adjuvant chemoradiation for gastric cancer. Int J Radiat Oncol Biol Phys, 2008, 71(4): 1167-1174.
20.	Dzierma Y, Nuesken FG, Fleckenstein JA, et al. Comparative planning of flattening-filter-free and flat beam IMRT for hypopharynx cancer as a function of beam and segment number. PLoS One, 2014, 9(4): e94371.
21.	Bzdusek K, Friberger H, Eriksson K, et al. Development and evaluation of an efficient approach to volumetric arc therapy planning. Med Phys, 2009, 36(6): 2328-2339.
22.	Fung-Kee-Fung SD, Hackett R, Hales L, et al. A prospective trial of volumetric intensity-modulated arc therapy vs conventional intensity modulated radiation therapy in advanced head and neck cancer. World J Clin Oncol, 2012, 3(4): 57-62.
23.	Bewes JM, Suchowerska N, Jackson M, et al. The radiobiological effect of intra-fraction dose-rate modulation in intensity modulated radiation therapy (IMRT). Phys Med Biol, 2008, 53(13): 3567-3578.
24.	Bratengeier K, Gainey MB, Flentje M. Fast IMRT by increasing the beam number and reducing the number of segments. Radiat Oncol, 2011, 6: 170.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Sasako M, Sano T, Yamamoto S, et al. D₂ lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med, 2008, 359(5): 453-462.
3. Lim DH, Kim DY, Kang MK, et al. Patterns of failure in gastric carcinoma after D₂ gastrectomy and chemoradiotherapy: a radiation oncologist's view. Br J Cancer, 2004, 91(1): 11-17.
4. Yoo CH, Noh SH, Shin DW, et al. Recurrence following curative resection for gastric carcinoma. Br J Surg, 2000, 87(2): 236-242.
5. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med, 2001, 345(10): 725-730.
6. Park SH, Sohn TS, Lee J, et al. Phase Ⅲ trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses. J Clin Oncol, 2015, 33(28): 3130-3136.
7. Alani S, Soyfer V, Strauss N, et al. Limited advantages of intensity-modulated radiotherapy over 3D conformal radiation therapy in the adjuvant management of gastric cancer. Int J Radiat Oncol Biol Phys, 2009, 74(2): 562-566.
8. Milano MT, Garofalo MC, Chmura SJ, et al. Intensity-modulated radiation therapy in the treatment of gastric cancer: early clinical outcome and dosimetric comparison with conventional techniques. Br J Radiol, 2006, 79(942): 497-503.
9. Hoogeman MS, Nuyttens JJ, Levendag PC, et al. Time dependence of intrafraction patient motion assessed by repeat stereoscopic imaging. Int J Radiat Oncol Biol Phys, 2008, 70(2): 609-618.
10. Teoh M, Clark CH, Wood K, et al. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol, 2011, 84(17): 967-996.
11. Edge SB, Compton CC. The American joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
12. Hess CF, Christ G, Jany R, et al. Dosage specification at the ICRU reference point: the consequences for clinical practice. Strahlenther Onkol, 1993, 169(11): 660-667.
13. Wambersie A, Landberg T, Prescribing GR. Recording and reporting photon beam therapy: the problem of margins (the recent ICRU recommendations, Report 62, 1999). Patras Medical Physics, 1999, 99(1): 25-31.
14. Smalley SR, Gunderson L, Tepper J, et al. Gastric surgical adjuvant radiotherapy consensus report: rationale and treatment implementation. Int J Radiat Oncol Biol Phys, 2002, 52(2): 283-293.
15. Tepper JE, Gunderson LL. Radiation treatment parameters in the adjuvant postoperative therapy of gastric cancer. Semin Radiat Oncol, 2002, 12(2): 187-195.
16. Daly-Schveitzer N, Julieron M, Tao YG, et al. Intensity-modulated radiation therapy (IMRT): toward a new standard for radiation therapy of head and neck cancer?. Eur Ann Otorhinolaryngol Head Neck Dis, 2011, 128(5): 241-247.
17. Gomez-Millan J, Fernandez JR, Medina CJ. Current status of IMRT in head and neck cancer. Reports of practical oncology and radiotherapy. Rep Pract Oncol Radiother, 2013, 18(6): 371-375.
18. Arbea L, Ramos L, Martinez-Monge R, et al. Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications. Radiat Oncol, 2010, 5: 17.
19. Chung HT, Lee B, Park E, et al. Can all centers plan intensity-modulated radiotherapy (IMRT) effectively? An external audit of dosimetric comparisons between three-dimensional conformal radiotherapy and IMRT for adjuvant chemoradiation for gastric cancer. Int J Radiat Oncol Biol Phys, 2008, 71(4): 1167-1174.
20. Dzierma Y, Nuesken FG, Fleckenstein JA, et al. Comparative planning of flattening-filter-free and flat beam IMRT for hypopharynx cancer as a function of beam and segment number. PLoS One, 2014, 9(4): e94371.
21. Bzdusek K, Friberger H, Eriksson K, et al. Development and evaluation of an efficient approach to volumetric arc therapy planning. Med Phys, 2009, 36(6): 2328-2339.
22. Fung-Kee-Fung SD, Hackett R, Hales L, et al. A prospective trial of volumetric intensity-modulated arc therapy vs conventional intensity modulated radiation therapy in advanced head and neck cancer. World J Clin Oncol, 2012, 3(4): 57-62.
23. Bewes JM, Suchowerska N, Jackson M, et al. The radiobiological effect of intra-fraction dose-rate modulation in intensity modulated radiation therapy (IMRT). Phys Med Biol, 2008, 53(13): 3567-3578.
24. Bratengeier K, Gainey MB, Flentje M. Fast IMRT by increasing the beam number and reducing the number of segments. Radiat Oncol, 2011, 6: 170.

West China Medical Journal

Optimization of beam sets and segments number in static intensity-modulated radiation therapy plans in radiotherapy of gastric cancer

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