The Journal of Korean Society for Radiation Therapy (대한방사선치료학회지)

Korean Society for Radiation Therapy (대한방사선치료학회)
권호 표지

Evaluation of the usefulness of Halcyon VMAT treatment plan through comparison with tomotherapy in bilateral breast cancer radiation therapy.

양측 유방암 방사선치료 시 토모테라피와의 비교를 통한 Halcyon VMAT 치료계획의 유용성 평가

  • LIM JUN TAEK (Department of Radiation Oncology, Samsung Medical Center) ;
  • PARK JU YOUNG (Department of Radiation Oncology, Samsung Medical Center) ;
  • PARK SU YEON (Department of Radiation Oncology, Samsung Medical Center) ;
  • JEON SEONG JIN (Department of Radiation Oncology, Samsung Medical Center) ;
  • PARK TAE YANG (Department of Radiation Oncology, Samsung Medical Center) ;
  • HWANG DA JIN (Department of Radiation Oncology, Samsung Medical Center)
  • 임준택 (삼성서울병원 방사선종양학과) ;
  • 박주영 (삼성서울병원 방사선종양학과) ;
  • 박수연 (삼성서울병원 방사선종양학과) ;
  • 전성진 (삼성서울병원 방사선종양학과) ;
  • 박태양 (삼성서울병원 방사선종양학과) ;
  • 황다진 (삼성서울병원 방사선종양학과)
  • Published : 2022.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To evaluate usefulness of Tomotherapy and Halcyon VMAT treatment in radiation therapy for bi-breast cancer Materials and Methods: For 10 patients with bi-breast cancer, volumetric modulated arc therapy(VMAT) treatment plan was established using helical Tomotherapy(Accuray. USA) with field width of 5.0-cm and pitch of 0.287, and Halcyon(Varian Medical System, Palo Alto, CA, Version 3.0 USA) of 6arc and 8arc. Prescribed dose was 42.4 Gy/16, and V 40.3Gy of Planning Target Volume(PTV) was 90%. The quality of plan was evaluated by comparing the dose to tumor and normal organs, and the efficiency was evaluated by comparing total MU and beam on time. Results: About three treatment plans(Tomotherapy, Halcyon 6Arc VMAT, Halcyon 8Arc VMAT) , the mean homogeneity index(H.I) of PTV were 1.07, 1.10, 1.11, and the mean conformity index(C.I) of PTV were 1.21, 1.16, 1.17, respectively. The average value of the dose assessment item for a normal organ is V 5Gy(%) of both lung was 36.3, 31.2, 29.7, and V 15Gy(%) were 18.6, 15.5, 14.6, respectively. The mean heart dose(Gy) were 4.17, 2.69, 2.51. Total MU were (7498.6, 2494.2, 2471.5), and beam on time(sec) were 462.5, 195.4, 198.0. Conclusion: Halcyon VMAT showed similar quality of treatment plan compared to helical Tomotherapy, while also protecting normal organs. In addition, the efficiency of radiotherapy increased due to a decrease in Beam On Time and MU.

목 적: 양측 유방암 방사선치료 시 토모테라피와 Halcyon 선형가속기을 이용한 치료계획을 비교하여 Halcyon 치료 계획의 유용성을 평가. 대상 및 방법: 양측 유방암 환자 10명을 대상으로 Helical Mode를 사용하여 조사면 고정 너비(Field Width, FW) 5.0-cm, 피치(Pitch) 0.287, 변조 지수(Modulation Factor) 2.4 조건의 토모테라피(Helical Tomotherapy, Accuray, USA)와 6Arc 및 8Arc의 Halcyon(Varian Medical System, Palo Alto, CA, Version 3.0 USA)을 이용한 용적변조회전치료(Volumetric Modulated Arc Therapy, VMAT)치료계획을 수립하였다. 총 처방 선량 42.4Gy/16회로 치료계획용적(Planning Target Volume, PTV)의 V 40.3Gy이 90% 이상이 되도록 하였다. 종양 및 정상 장기의 선량을 비교하여 치료 계획의 질을 평가하였고 Total MU와 Beam On Time을 비교하여 효율성을 평가하였다. 결 과: 대상 환자들의 3개 치료계획 (Tomotherapy, Halcyon 6Arc VMAT, Halcyon 8Arc VMAT)의 평가 항목 평균 값은 PTV의 H.I (Homogeneity Index)는 각각 1.07, 1.10, 1.11, PTV의 C.I (Conformity Index)는 각각 1.21, 1.16, 1.17 이었다. 정상 장기의 선량 평가 항목 평균 값은 BOTH LUNG의 V 5Gy는 각각 36.3%, 31.2%, 29.7% 이며, V 15Gy는 각각 18.6%, 15.5%, 14.6% 이었다. HEART의 평균 선량(Gy)은 각각 4.17, 2.69, 2.51 이었다. Total MU의 평균 값은 각각 7498.6, 2494.2, 2471.5 이며 Beam On Time (sec)의 평균 값은 각각 462.5, 195.4, 198 로 토모테라피와 비교하여 Halcyon VMAT 치료계획이 Beam On Time과 Total MU가 감소하였다. 결 론: Halcyon VMAT은 토모테라피와 비교하였을 때 유사한 치료 계획의 질을 보여주며 정상 장기의 더 높은 보호 효과를 나타내었다. 또한 Beam On Time과 Total MU의 감소로 방사선치료의 효율성이 증가하였다.

Keywords

References

  1. American Cancer Society. Cancer Facts & Figures 2018. Atlanta: American Cancer Society. 2018;3-12
  2. 암종별 발생 현황, National Cancer Information Center, KOSIS, 2019
  3. P. Jardel, J. Thariat, P. Blanchard, et al.: Nasopharyngeal cancers, an overview. Bulletin du Cancer. 2014;101(5):445-454 https://doi.org/10.1684/bdc.2014.1964
  4. Yi Rong, James S Welsh: Dosimetric and clinical review of Tomo tomotherapy. Expert Review of Anticancer Therapy. 2011;11(2):309-320 https://doi.org/10.1586/era.10.175
  5. Jie Qiu, Zhikai Liu, Bo Yang, Xiaorong Hou, et al.: Low-Dose-Area-Constrainted Tomo TomoTherapy-Based Whole Breast Radiotherapy and Dosimetric Comparison with Tangential Field-in-Field IMRT. BioMed Research International. 2013;10.1155.
  6. Barsky AR, O'Grady F, Kennedy C, et al. Initial clinical experience treating patients with breast cancer on a 6-MV flattening-filter-free o-ring linear accelerator. Adv Radiat Oncol. 2019;4(4)571-578 https://doi.org/10.1016/j.adro.2019.05.006
  7. Michiels S, Poels K, Crijns W, et al. Volumetric modulated arc therapy of head-and-neck cancer on a fast-rotating o-ring linac: plan quality and delivery time comparison with a c-arm linac. Radiother Oncol. 2018;128(3):479-484. https://doi.org/10.1016/j.radonc.2018.04.021
  8. Radiation Therapy Oncology Group (RTOG) 1005 A phase III trial of accelerated whole breast irradiation with hypofractionation plus concurrent boost versus standard whole breast irradiation plus sequential boost for early-stage breast cancer (2014)
  9. S. Rudra, H.A. Al-Hallaq, Feng C., et al. Effect of RTOG breast/chest wall guidelines on dose-volume histogram parameters Int. J. Radiat. Oncol. Biol. Phys. (2014);15(2):127-137
  10. S.K. Moon, Y.S. Kim, S.Y. Kim, et al. A dosimetric analysis of IMRT and multistatic fields techniques for left breast radiotherapy Med. Dosim. (2011);36(3):276-278 https://doi.org/10.1016/j.meddos.2010.05.003
  11. Deva Petrova , Snezana Smickovska , Emilija Lazarevska, et al Conformity Index and Homogeneity Index of the Postoperative Whole Breast Radiotherapy Open Access Maced J Med Sci. (2017);5(6):736-739.
  12. Sung JinKimM.S, Mi JoLeeMD, Seon MinYounMD, et al. Radiation therapy of synchronous bilateral breast carcinoma (SBBC) using multiple techniques. (2018);43 (1):55-68 https://doi.org/10.1016/j.meddos.2017.08.003
  13. Tao Sun, Xiutong Lin, Guifang Zhang, et al. Treatment planning comparison of volumetric modulated arc therapy with the trilogy and the Halcyon for bilateral breast cancer. (2021);16(35)
  14. Karlsen Jarle, Tandstad Torgrim, Sowa Piotr, et al. Pneumonitis and fibrosis after breast cancer radiotherapy: occurrence and treatment-related predictors. Acta oncologica (2021);60(12):.1651-1658 https://doi.org/10.1080/0284186X.2021.1976828
  15. Byung Min Lee, Jee Suk Chang, Se Young Kim, et al. Hypofractionated Radiotherapy Dose Scheme and Application of New Techniques Are Associated to a Lower Incidence of Radiation Pneumonitis in Breast Cancer Patients. Frontiers in Oncology. Frontiers Media SA. (2020);00124.
  16. Marc D. Piroth, Rene Baumann, Wilfried Budach, et al. Heart toxicity frombreast cancer radiotherapy. Strahlenther Onkol. (2019);195:1-12
  17. Darby S, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. (2013);368(11):987-998. https://doi.org/10.1056/NEJMoa1209825
  18. Rossi M, Boman E, Skytta T, et al. Dosimetric effects of anatomical deformations and positioning errors in VMAT breast radiotherapy. J Appl Clin Med Phys. (2018);19(5):506-516. https://doi.org/10.1002/acm2.12409
  19. 윤보름, 홍미란, 안종호 등: Tomotherapy MVCT와 Linac CBCT의 Imaging dose 비교평가 Compare to Evaluate the Imaging dose of MVCT and CBCT. The Journal of Korean Society for Radiation Therapy. (2014);26(1):83-89
  20. 김성진: 최신 방사선치료에서의 방사선 세기 변조 복잡성 분석. 국내박사학위논문 영남대학교 대학원, 2020. 
  21. Li R, Xing L. An adaptive planning strategy for station parameter optimized radiationtherapy (SPORT): Segmentally boosted VMAT. Med Phys. (2013);40:050701.