title: Lung stereotactic ablative body radiotherapy: A large scale multi-institutional planning comparison for interpreting results of multi-institutional studies.
abstract: OBJECTIVE
  A large-scale multi-institutional planning comparison on lung cancer SABR is presented with the aim of investigating possible criticism in carrying out retrospective multicentre data analysis from a dosimetric perspective.
  
  
  METHODS
  Five CT series were sent to the participants. The dose prescription to PTV was 54Gy in 3 fractions of 18Gy. The plans were compared in terms of PTV-gEUD2 (generalized Equivalent Uniform Dose equivalent to 2Gy), mean dose to PTV, Homogeneity Index (PTV-HI), Conformity Index (PTV-CI) and Gradient Index (PTV-GI). We calculated the maximum dose for each OAR (organ at risk) considered as well as the MLD2 (mean lung dose equivalent to 2Gy). The data were stratified according to expertise and technology.
  
  
  RESULTS
  Twenty-six centers equipped with Linacs, 3DCRT (4% - 1 center), static IMRT (8% - 2 centers), VMAT (76% - 20 centers), CyberKnife (4% - 1 center), and Tomotherapy (8% - 2 centers) collaborated. Significant PTV-gEUD2 differences were observed (range: 105-161Gy); mean-PTV dose, PTV-HI, PTV-CI, and PTV-GI were, respectively, 56.8±3.4Gy, 14.2±10.1%, 0.70±0.15, and 4.9±1.9. Significant correlations for PTV-gEUD2 versus PTV-HI, and MLD2 versus PTV-GI, were observed.
  
  
  CONCLUSIONS
  The differences in terms of PTV-gEUD2 may suggest the inclusion of PTV-gEUD2 calculation for retrospective data inter-comparison.
authors.affiliation: A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy. Electronic address: francescaromanagiglioli@gmail.com.
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Giglioli
authors.affiliation: Regina Elena Cancer Center IFO, Roma, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Strigari
authors.affiliation: Dep. of Oncology, Radiation Oncology Unit, University of Torino, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ragona
authors.affiliation: REM Radioterapia, Catania, Italy.
authors.forename: Giuseppina R
authors.initials: GR
authors.lastname: Borzì
authors.affiliation: IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cagni
authors.affiliation: ASST "Grande Ospedale Metropolitano Niguarda", Milano, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Carbonini
authors.affiliation: Azienda Ospedaliera Universitaria Federico II Napoli, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Clemente
authors.affiliation: Fisica Sanitaria ACO San Filippo Neri, Roma, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Consorti
authors.affiliation: O. San Pietro Fatebenefratelli, Roma, Italy.
authors.forename: Randa
authors.initials: R
authors.lastname: El Gawhary
authors.affiliation: Azienda Sanitaria Firenze, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Esposito
authors.affiliation: Fondazione Policlinico Tor Vergata, Roma, Italy.
authors.forename: Maria Daniela
authors.initials: MD
authors.lastname: Falco
authors.affiliation: Casa di Cura Privata San Rossore, Pisa, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Fedele
authors.affiliation: Dep. of Oncology, Radiation Oncology Unit, University of Torino, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Fiandra
authors.affiliation: Mater Dei Hospital, C.B.H. Città di Bari Hospital s.p.a., Bari, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Frassanito
authors.affiliation: Regina Elena Cancer Center IFO, Roma, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Landoni
authors.affiliation: A.O.U. Maggiore della Carità di Novara, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Loi
authors.affiliation: U.O. Fisica Sanitaria Azienda USL 1 Massa e Carrara, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Lorenzini
authors.affiliation: Medical Physics Dept, University Hospital of Udine, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Malisan
authors.affiliation: Humanitas C.C.O., Catania, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Marino
authors.affiliation: IRCCS - IRST, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Menghi
authors.affiliation: UPMC San Pietro FBF, Roma, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Nardiello
authors.affiliation: Ospedale S.Camillo de Lellis, Rieti, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Nigro
authors.affiliation: IRCCS CROB Rionero in Vulture (OZ), Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Oliviero
authors.affiliation: Ecomedica Empoli, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pastore
authors.affiliation: S.C. Fisica Sanitaria USL 2 Lucca, Italy.
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Quattrocchi
authors.affiliation: Ospedale Sacro Cuore - don Calabria, Negrar (VR), Italy.
authors.forename: Ruggero
authors.initials: R
authors.lastname: Ruggieri
authors.affiliation: A.O. San Gerardo di Monza, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Redaelli
authors.affiliation: Medical Physics Unit of Radiotherapy Dept. Humanitas Clinical and Research Hospital, Rozzano (MI), Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Reggiori
authors.affiliation: Azienda Sanitaria Firenze, Italy.
authors.forename: Serenella
authors.initials: S
authors.lastname: Russo
authors.affiliation: AUSL Piacenza, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Villaggi
authors.affiliation: AOU Careggi, Firenze, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Casati
authors.affiliation: Medical Physics Unit of Radiotherapy Dept. Humanitas Clinical and Research Hospital, Rozzano (MI), Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancosu
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Dosimetry; Lung; Multicentric clinical trial; Radiobiology; Stereotactic ablative radiotherapy (SABR); Stereotactic body radiation therapy (SBRT)