N. Reynaert

Adapted Prescription Dose for Monte Carlo Algorithm in Lung SBRT: Clinical Outcome on 205 Patients

Purpose SBRT is the standard of care for inoperable patients with early-stage lung cancer without lymph node involvement. Excellent local control rates have been reported in a large number of series. However, prescription doses and calculation algorithms vary to a great extent between studies, even if most teams prescribe to the D95 of the PTV. Type A algorithms are known to produce dosimetric discrepancies in heterogeneous tissues such as lungs. This study was performed to present a Monte Carlo (MC) prescription dose for NSCLC adapted to lesion size and location and compare the clinical outcomes of two cohorts of patients treated with a standard prescription dose calculated by a type A algorithm or the proposed MC protocol. Patients and Methods Patients were treated from January 2011 to April 2013 with a type B algorithm (MC) prescription with 54 Gy in three fractions for peripheral lesions with a diameter under 30 mm, 60 Gy in 3 fractions for lesions with a diameter over 30 mm, and 55 Gy in five fractions for central lesions. Clinical outcome was compared to a series of 121 patients treated with a type A algorithm (TA) with three fractions of 20 Gy for peripheral lesions and 60 Gy in five fractions for central lesions prescribed to the PTV D95 until January 2011. All treatment plans were recalculated with both algorithms for this study. Spearman’s rank correlation coefficient was calculated for GTV and PTV. Local control, overall survival and toxicity were compared between the two groups. Results 205 patients with 214 lesions were included in the study. Among these, 93 lesions were treated with MC and 121 were treated with TA. Overall survival rates were 86% and 94% at one and two years, respectively. Local control rates were 79% and 93% at one and two years respectively. There was no significant difference between the two groups for overall survival (p = 0.785) or local control (p = 0.934). Fifty-six patients (27%) developed grade I lung fibrosis without clinical consequences. GTV size was a prognostic factor for overall survival (HR = 1.026, IC95% [1.01–1.041], p<0.001) and total dose was a prognostic factor for local control (HR = 0.924, IC95% [0.870–0.982], p = 0.011). D50 of the GTV calculated with MC correlated poorly with the D95 of the PTV calculated with TA (r = 0.116) for lesions with a diameter of 20 mm or less. For lesions larger than 20 mm, spearman correlation was higher (r = 0.618), but still insufficient. Conclusion No difference in local control or overall survival was found between patients treated with a type A or a type B algorithm in our cohort. A size and location adapted GTV-based prescription method could be used with a type B algorithm. External validation of these results is warranted.

What is the normal tissues morbidity following Helical Intensity Modulated Radiation Treatment for cervical cancer

BACKGROUND AND PURPOSE To report on normal tissues morbidity following IMRT for cervix cancer. MATERIAL AND METHODS The first 61 patients of a prospective series were included. 50 Gy to the PTV 1(pelvis) and 60 Gy to the PTV 2 (centro-pelvic disease and GTV nodes) were delivered concomitantly in 28 fractions, followed by a brachytherapy boost. For the small bowel, 50 Gy was the maximal dose, while V45 and V40 had to be <50 cc and 200 cc, respectively. For the bladder, rectum and sigmoid structures, 60 Gy was the maximal dose, and V45 and V40 had to be <20% and <50%. Acute and late toxicity data were prospectively collected. RESULTS The median follow-up period was 40 months (range: 23-60). 30% and 90% of acute and moderate late side effects were reported respectively. Considering the AUC data of the organs at risk (OAR) DVH, late morbidity and doses were significantly linked (p⩽0.03), predominantly between 10 Gy and 40 Gy, considering the small bowel and sigmoid colon. The high dose regions exhibited no significant impact. CONCLUSION The moderate dose volumes represent the predominant cause of morbidity after IMRT. Prospective trials are thus required to investigate new ways of dose distribution within the OAR.

EP-1246: Tracking of hepatic lesions: Correlation between the movements of target and fiducials during breathing cycle

the exhalation phase. Before the treatment delivery, the RPM block was put on patient’s abdominal surface and the gating signal was generated by the RPM system. Then, the patient’s position was set based on cone beam computed tomography (CBCT) compare with ITV. During the treatment, kv images were acquired at each exhalation phase of the breathing cycle and the positions of the fiducial markers were compared with their expected positions. We reported here for the five first fractions the differences between expected and real fiducial position, treatment planning parameters such as the prescription, conformity index CIPTV = (VITV95% (cc) / VPTV (cc)) * (VITV95% (cc) / Viso95% (cc)), homogeneity index HIPTV = (D2% D98%) / Dmedian and the number of Monitor Unit (UM) per Gray. The treatment delivery parameters such as kv images acquired per fraction, the fraction’s time and the room occupation’s time were also mentioned. Results: For the eight PTV patients, the average (±SD) conformity index was 0,93 ± 0,02 and homogeneity index was 0,09 ± 0,02. Average MU/Gy was 147 ± 25.