Simultaneous tumour dose escalation and liver sparing in Stereotactic Body Radiation Therapy (SBRT) for liver tumours due to CTV-to-PTV margin reduction.
OBJECTIVE
To quantify potential benefits of CTV-to-PTV margin reduction for SBRT of liver tumours, as allowed by enhanced treatment precision.


METHODS
For 14 patients plans were generated for the clinical margin and for 3 tighter margins. An in-house developed algorithm was used to optimise beam directions, shapes, and weights for generation of the plan with the highest isocenter dose (D(iso)), while keeping the minimum PTV dose at least 65%xD(iso) and strictly adhering to all imposed hard OAR constraints. Each plan contains 10 optimal beam directions, automatically selected from up to 252 coplanar and non-coplanar input directions.


RESULTS
Apart from the expected tumour dose escalation (D(iso), EUD(PTV), gEUD(PTV)) with decreasing margin, a simultaneous improved sparing of the normal liver (D33%, D50%, D(mean)) was also observed. The smaller the margin was, the bigger both effects were. For renormalized plans with D(iso) equal to the clinical value (3x19.2Gy), and a margin reduction of 50% (2.5mm laterally, 5mm longitudinally), normal liver D33% and D50% reduced on average by 22% (maximum 38%), and 26% (maximum 47%), respectively.


CONCLUSIONS
Using an algorithm for beam direction, shape and weight optimisation, large increases in the therapeutic ratio of liver plans could be obtained for reduced margins.
Molinelli
Silvia
S
Department of Radiation Oncology, Erasmus MC - Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. silvia.molinelli@pv.infn.it
de Pooter
Jacco
J
Méndez Romero
Alejandra
A
Wunderink
Wouter
W
Cattaneo
Mauro
M
Calandrino
Riccardo
R
Heijmen
Ben
B
D000465:Algorithms; D006801:Humans; D008099:Liver / Q000528:radiation effects; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D014057:Tomography, X-Ray Computed