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Intensity modulated arc therapy implementation in a three phase adaptive 18F-FDG-PET voxel intensity-based planning strategy for head-and-neck cancer

Dieter Berwouts (UGent) , Ana Maria Luiza Olteanu (UGent) , Bruno Speleers (UGent) , Fréderic Duprez (UGent) , Indira Madani (UGent) , Tom Vercauteren (UGent) , Wilfried De Neve (UGent) and Werner De Gersem (UGent)
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Abstract
Background: This study investigates the implementation of a new intensity modulated arc therapy (IMAT) class solution in comparison to a 6-static beam step-and-shoot intensity modulated radiotherapy (s-IMRT) for three-phase adaptive F-18-FDG-PET-voxel-based dose-painting-by-numbers (DPBN) for head-and-neck cancer. Methods: We developed F-18-FDG-PET-voxel intensity-based IMAT employing multiple arcs and compared it to clinically used s-IMRT DPBN. Three IMAT plans using F-18-FDG-PET/CT acquired before treatment (phase I), after 8 fractions (phase II) and CT acquired after 18 fractions (phase III) were generated for each of 10 patients treated with 3 s-IMRT plans based on the same image sets. Based on deformable image registration (ABAS, version 0.41, Elekta CMS Software, Maryland Heights, MO), doses of the 3 plans were summed on the pretreatment CT using validated in-house developed software. Dosimetric indices in targets and organs-at-risk (OARs), biologic conformity of treatment plans set at <= 5 %, treatment quality and efficiency were compared between IMAT and s-IMRT for the whole group and for individual patients. Results: Doses to most organs-at-risk (OARs) were significantly better in IMAT plans, while target levels were similar for both types of plans. On average, IMAT ipsilateral and contralateral parotid mean doses were 14.0 % (p = 0.001) and 12.7 % (p < 0.001) lower, respectively. Pharyngeal constrictors D-50% levels were similar or reduced with up to 54.9 % for IMAT compared to s-IMRT for individual patient cases. IMAT significantly improved biologic conformity by 2.1 % for treatment phases I and II. 3D phantom measurements reported an agreement of >= 95 % for 3 % and 3 mm criteria for both treatment modalities. IMAT delivery time was significantly shortened on average by 41.1 %. Conclusions: IMAT implementation significantly improved the biologic conformity as compared to s-IMRT in adaptive dose-escalated DPBN treatments. The better OAR sparing and faster delivery highly improved the treatment efficiency.
Keywords
Intensity modulated radiotherapy, Head-and-neck cancer, Dose-painting, Adaptive intensity modulated arc therapy, RADIATION-THERAPY, OROPHARYNGEAL CANCER, HELICAL TOMOTHERAPY, IMRT, RADIOTHERAPY, CARCINOMA, VMAT, OPTIMIZATION, SMARTARC, DELIVERY

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MLA
Berwouts, Dieter et al. “Intensity Modulated Arc Therapy Implementation in a Three Phase Adaptive 18F-FDG-PET Voxel Intensity-based Planning Strategy for Head-and-neck Cancer.” RADIATION ONCOLOGY 11 (2016): n. pag. Print.
APA
Berwouts, D., Olteanu, A. M. L., Speleers, B., Duprez, F., Madani, I., Vercauteren, T., De Neve, W., et al. (2016). Intensity modulated arc therapy implementation in a three phase adaptive 18F-FDG-PET voxel intensity-based planning strategy for head-and-neck cancer. RADIATION ONCOLOGY, 11.
Chicago author-date
Berwouts, Dieter, Ana Maria Luiza Olteanu, Bruno Speleers, Fréderic Duprez, Indira Madani, Tom Vercauteren, Wilfried De Neve, and Werner De Gersem. 2016. “Intensity Modulated Arc Therapy Implementation in a Three Phase Adaptive 18F-FDG-PET Voxel Intensity-based Planning Strategy for Head-and-neck Cancer.” Radiation Oncology 11.
Chicago author-date (all authors)
Berwouts, Dieter, Ana Maria Luiza Olteanu, Bruno Speleers, Fréderic Duprez, Indira Madani, Tom Vercauteren, Wilfried De Neve, and Werner De Gersem. 2016. “Intensity Modulated Arc Therapy Implementation in a Three Phase Adaptive 18F-FDG-PET Voxel Intensity-based Planning Strategy for Head-and-neck Cancer.” Radiation Oncology 11.
Vancouver
1.
Berwouts D, Olteanu AML, Speleers B, Duprez F, Madani I, Vercauteren T, et al. Intensity modulated arc therapy implementation in a three phase adaptive 18F-FDG-PET voxel intensity-based planning strategy for head-and-neck cancer. RADIATION ONCOLOGY. 2016;11.
IEEE
[1]
D. Berwouts et al., “Intensity modulated arc therapy implementation in a three phase adaptive 18F-FDG-PET voxel intensity-based planning strategy for head-and-neck cancer,” RADIATION ONCOLOGY, vol. 11, 2016.
@article{8037032,
  abstract     = {Background: This study investigates the implementation of a new intensity modulated arc therapy (IMAT) class solution in comparison to a 6-static beam step-and-shoot intensity modulated radiotherapy (s-IMRT) for three-phase adaptive F-18-FDG-PET-voxel-based dose-painting-by-numbers (DPBN) for head-and-neck cancer. 
Methods: We developed F-18-FDG-PET-voxel intensity-based IMAT employing multiple arcs and compared it to clinically used s-IMRT DPBN. Three IMAT plans using F-18-FDG-PET/CT acquired before treatment (phase I), after 8 fractions (phase II) and CT acquired after 18 fractions (phase III) were generated for each of 10 patients treated with 3 s-IMRT plans based on the same image sets. Based on deformable image registration (ABAS, version 0.41, Elekta CMS Software, Maryland Heights, MO), doses of the 3 plans were summed on the pretreatment CT using validated in-house developed software. Dosimetric indices in targets and organs-at-risk (OARs), biologic conformity of treatment plans set at <= 5 %, treatment quality and efficiency were compared between IMAT and s-IMRT for the whole group and for individual patients. 
Results: Doses to most organs-at-risk (OARs) were significantly better in IMAT plans, while target levels were similar for both types of plans. On average, IMAT ipsilateral and contralateral parotid mean doses were 14.0 % (p = 0.001) and 12.7 % (p < 0.001) lower, respectively. Pharyngeal constrictors D-50% levels were similar or reduced with up to 54.9 % for IMAT compared to s-IMRT for individual patient cases. IMAT significantly improved biologic conformity by 2.1 % for treatment phases I and II. 3D phantom measurements reported an agreement of >= 95 % for 3 % and 3 mm criteria for both treatment modalities. IMAT delivery time was significantly shortened on average by 41.1 %. 
Conclusions: IMAT implementation significantly improved the biologic conformity as compared to s-IMRT in adaptive dose-escalated DPBN treatments. The better OAR sparing and faster delivery highly improved the treatment efficiency.},
  articleno    = {52},
  author       = {Berwouts, Dieter and Olteanu, Ana Maria Luiza and Speleers, Bruno and Duprez, Fréderic and Madani, Indira and Vercauteren, Tom and De Neve, Wilfried and De Gersem, Werner},
  issn         = {1748-717X},
  journal      = {RADIATION ONCOLOGY},
  keywords     = {Intensity modulated radiotherapy,Head-and-neck cancer,Dose-painting,Adaptive intensity modulated arc therapy,RADIATION-THERAPY,OROPHARYNGEAL CANCER,HELICAL TOMOTHERAPY,IMRT,RADIOTHERAPY,CARCINOMA,VMAT,OPTIMIZATION,SMARTARC,DELIVERY},
  language     = {eng},
  pages        = {9},
  title        = {Intensity modulated arc therapy implementation in a three phase adaptive 18F-FDG-PET voxel intensity-based planning strategy for head-and-neck cancer},
  url          = {http://dx.doi.org/10.1186/s13014-016-0629-3},
  volume       = {11},
  year         = {2016},
}

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