Stereotactic body radiation therapy for liver tumours using flattening filter free beam: Dosimetric and technical considerations

Pietro Mancosu, Simona Castiglioni, Giacomo Reggiori, Maddalena Catalano, Filippo Alongi, Chiara Pellegrini, Stefano Arcangeli, Angelo Tozzi, Francesca Lobefalo, Antonella Fogliata, Piera Navarria, Luca Cozzi, Marta Scorsetti

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Purpose: To report the initial institute experience in terms of dosimetric and technical aspects in stereotactic body radiation therapy (SBRT) delivered using flattening filter free (FFF) beam in patients with liver lesions.Methods and Materials: From October 2010 to September 2011, 55 consecutive patients with 73 primary or metastatic hepatic lesions were treated with SBRT on TrueBeam using FFF beam and RapidArc technique. Clinical target volume (CTV) was defined on multi-phase CT scans, PET/CT, MRI, and 4D-CT. Dose prescription was 75 Gy in 3 fractions to planning target volume (PTV). Constraints for organs at risk were: 700 cc of liver free from the 15 Gy isodose, D max <21 Gy for stomach and duodenum, D max <30 Gy for heart, D 0.1 cc <18 Gy for spinal cord, V 15 Gy <35% for kidneys. The dose was downscaled in cases of not full achievement of dose constraints. Daily cone beam CT (CBCT) was performed.Results: Forty-three patients with a single lesion, nine with two lesions and three with three lesions were treated with this protocol. Target and organs at risk objectives were met for all patients. Mean delivery time was 2.8 ± 1.0 min. Pre-treatment plan verification resulted in a Gamma Agreement Index of 98.6 ± 0.8%. Mean on-line co-registration shift of the daily CBCT to the simulation CT were: -0.08, 0.05 and -0.02 cm with standard deviations of 0.33, 0.39 and 0.55 cm in, vertical, longitudinal and lateral directions respectively.Conclusions: SBRT for liver targets delivered by means of FFF resulted to be feasible with short beam on time.

Original languageEnglish
Article number16
JournalRadiation Oncology
Volume7
Issue number1
DOIs
Publication statusPublished - Feb 1 2012

Fingerprint

Radiotherapy
Organs at Risk
Liver
Neoplasms
Cone-Beam Computed Tomography
Duodenum
Positron-Emission Tomography
Prescriptions
Spinal Cord
Stomach
Kidney
Therapeutics

Keywords

  • Flattening filter free
  • Liver
  • RapidArc
  • SBRT
  • TrueBeam

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Stereotactic body radiation therapy for liver tumours using flattening filter free beam : Dosimetric and technical considerations. / Mancosu, Pietro; Castiglioni, Simona; Reggiori, Giacomo; Catalano, Maddalena; Alongi, Filippo; Pellegrini, Chiara; Arcangeli, Stefano; Tozzi, Angelo; Lobefalo, Francesca; Fogliata, Antonella; Navarria, Piera; Cozzi, Luca; Scorsetti, Marta.

In: Radiation Oncology, Vol. 7, No. 1, 16, 01.02.2012.

Research output: Contribution to journalArticle

Mancosu, Pietro ; Castiglioni, Simona ; Reggiori, Giacomo ; Catalano, Maddalena ; Alongi, Filippo ; Pellegrini, Chiara ; Arcangeli, Stefano ; Tozzi, Angelo ; Lobefalo, Francesca ; Fogliata, Antonella ; Navarria, Piera ; Cozzi, Luca ; Scorsetti, Marta. / Stereotactic body radiation therapy for liver tumours using flattening filter free beam : Dosimetric and technical considerations. In: Radiation Oncology. 2012 ; Vol. 7, No. 1.
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abstract = "Purpose: To report the initial institute experience in terms of dosimetric and technical aspects in stereotactic body radiation therapy (SBRT) delivered using flattening filter free (FFF) beam in patients with liver lesions.Methods and Materials: From October 2010 to September 2011, 55 consecutive patients with 73 primary or metastatic hepatic lesions were treated with SBRT on TrueBeam using FFF beam and RapidArc technique. Clinical target volume (CTV) was defined on multi-phase CT scans, PET/CT, MRI, and 4D-CT. Dose prescription was 75 Gy in 3 fractions to planning target volume (PTV). Constraints for organs at risk were: 700 cc of liver free from the 15 Gy isodose, D max <21 Gy for stomach and duodenum, D max <30 Gy for heart, D 0.1 cc <18 Gy for spinal cord, V 15 Gy <35{\%} for kidneys. The dose was downscaled in cases of not full achievement of dose constraints. Daily cone beam CT (CBCT) was performed.Results: Forty-three patients with a single lesion, nine with two lesions and three with three lesions were treated with this protocol. Target and organs at risk objectives were met for all patients. Mean delivery time was 2.8 ± 1.0 min. Pre-treatment plan verification resulted in a Gamma Agreement Index of 98.6 ± 0.8{\%}. Mean on-line co-registration shift of the daily CBCT to the simulation CT were: -0.08, 0.05 and -0.02 cm with standard deviations of 0.33, 0.39 and 0.55 cm in, vertical, longitudinal and lateral directions respectively.Conclusions: SBRT for liver targets delivered by means of FFF resulted to be feasible with short beam on time.",
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AU - Mancosu, Pietro

AU - Castiglioni, Simona

AU - Reggiori, Giacomo

AU - Catalano, Maddalena

AU - Alongi, Filippo

AU - Pellegrini, Chiara

AU - Arcangeli, Stefano

AU - Tozzi, Angelo

AU - Lobefalo, Francesca

AU - Fogliata, Antonella

AU - Navarria, Piera

AU - Cozzi, Luca

AU - Scorsetti, Marta

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N2 - Purpose: To report the initial institute experience in terms of dosimetric and technical aspects in stereotactic body radiation therapy (SBRT) delivered using flattening filter free (FFF) beam in patients with liver lesions.Methods and Materials: From October 2010 to September 2011, 55 consecutive patients with 73 primary or metastatic hepatic lesions were treated with SBRT on TrueBeam using FFF beam and RapidArc technique. Clinical target volume (CTV) was defined on multi-phase CT scans, PET/CT, MRI, and 4D-CT. Dose prescription was 75 Gy in 3 fractions to planning target volume (PTV). Constraints for organs at risk were: 700 cc of liver free from the 15 Gy isodose, D max <21 Gy for stomach and duodenum, D max <30 Gy for heart, D 0.1 cc <18 Gy for spinal cord, V 15 Gy <35% for kidneys. The dose was downscaled in cases of not full achievement of dose constraints. Daily cone beam CT (CBCT) was performed.Results: Forty-three patients with a single lesion, nine with two lesions and three with three lesions were treated with this protocol. Target and organs at risk objectives were met for all patients. Mean delivery time was 2.8 ± 1.0 min. Pre-treatment plan verification resulted in a Gamma Agreement Index of 98.6 ± 0.8%. Mean on-line co-registration shift of the daily CBCT to the simulation CT were: -0.08, 0.05 and -0.02 cm with standard deviations of 0.33, 0.39 and 0.55 cm in, vertical, longitudinal and lateral directions respectively.Conclusions: SBRT for liver targets delivered by means of FFF resulted to be feasible with short beam on time.

AB - Purpose: To report the initial institute experience in terms of dosimetric and technical aspects in stereotactic body radiation therapy (SBRT) delivered using flattening filter free (FFF) beam in patients with liver lesions.Methods and Materials: From October 2010 to September 2011, 55 consecutive patients with 73 primary or metastatic hepatic lesions were treated with SBRT on TrueBeam using FFF beam and RapidArc technique. Clinical target volume (CTV) was defined on multi-phase CT scans, PET/CT, MRI, and 4D-CT. Dose prescription was 75 Gy in 3 fractions to planning target volume (PTV). Constraints for organs at risk were: 700 cc of liver free from the 15 Gy isodose, D max <21 Gy for stomach and duodenum, D max <30 Gy for heart, D 0.1 cc <18 Gy for spinal cord, V 15 Gy <35% for kidneys. The dose was downscaled in cases of not full achievement of dose constraints. Daily cone beam CT (CBCT) was performed.Results: Forty-three patients with a single lesion, nine with two lesions and three with three lesions were treated with this protocol. Target and organs at risk objectives were met for all patients. Mean delivery time was 2.8 ± 1.0 min. Pre-treatment plan verification resulted in a Gamma Agreement Index of 98.6 ± 0.8%. Mean on-line co-registration shift of the daily CBCT to the simulation CT were: -0.08, 0.05 and -0.02 cm with standard deviations of 0.33, 0.39 and 0.55 cm in, vertical, longitudinal and lateral directions respectively.Conclusions: SBRT for liver targets delivered by means of FFF resulted to be feasible with short beam on time.

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