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Monte Carlo evaluation of target dose coverage in lung stereotactic body radiation therapy with flattening filter-free beams

Published online by Cambridge University Press:  16 October 2020

Oleg N. Vassiliev Open the ORCID record for Oleg N. Vassiliev [Opens in a new window] ,
Christine B. Peterson ,
Joe Y. Chang  and
Radhe Mohan
Oleg N. Vassiliev*
Affiliation:
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Christine B. Peterson
Affiliation:
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Joe Y. Chang
Affiliation:
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Radhe Mohan
Affiliation:
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
*
Author for correspondence: Oleg N. Vassiliev, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX77030, USA. Tel: 713-745-7995. Fax: 713-563-6949. E-mail: onvassil@mdanderson.org
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Abstract

Aim:

Previous studies showed that replacing conventional flattened beams (FF) with flattening filter-free (FFF) beams improves the therapeutic ratio in lung stereotactic body radiation therapy (SBRT), but these findings could have been impacted by dose calculation uncertainties caused by the heterogeneity of the thoracic anatomy and by respiratory motion, which were particularly high for target coverage. In this study, we minimised such uncertainties by calculating doses using high-spatial-resolution Monte Carlo and four-dimensional computed tomography (4DCT) images. We aimed to evaluate more reliably the benefits of using FFF beams for lung SBRT.

Materials and methods:

For a cohort of 15 patients with early-stage lung cancer that we investigated in a previous treatment planning study, we recalculated dose distributions with Monte Carlo using 4DCT images. This included 15 FF and 15 FFF treatment plans.

Results:

Compared to Monte Carlo, the treatment planning system (TPS) over-predicted doses in low-dose regions of the planning target volume (PTV). For most patients, replacing FF beams with FFF beams improved target coverage, tumour control, and uncomplicated tumour control probabilities.

Conclusions:

Monte Carlo tends to reveal deficiencies in target coverage compared to coverage predicted by the TPS. Our data support previously reported benefits of using FFF beams for lung SBRT.

Keywords

flattening filter-free beamslung stereotactic body radiation therapytumor control probabilitynormal tissue complication probabilityMonte Carlo
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 1 , March 2022 , pp. 81 - 87
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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