title: Dosimetric evaluation of total marrow irradiation using 2 different planning systems.
abstract: This study compared 2 different treatment planning systems (TPSs) for quality and efficiency of total marrow irradiation (TMI) plans. The TPSs used in this study were VOxel-Less Optimization (VoLO) (Accuray Inc, Sunnyvale, CA) using helical dose delivery on a Tomotherapy Hi-Art treatment unit and Eclipse (Varian Medical Systems Inc, Palo Alto, CA) using volumetric modulated arc therapy (VMAT) dose delivery on a Varian iX treatment unit. A total dose of 1200cGy was prescribed to cover 95% of the planning target volume (PTV). The plans were optimized and calculated based on a single CT data and structure set using the Alderson Rando phantom (The Phantom Laboratory, Salem, NY) and physician contoured target and organ at risk (OAR) volumes. The OARs were lungs, heart, liver, kidneys, brain, and small bowel. The plans were evaluated based on plan quality, time to optimize the plan and calculate the dose, and beam on time. The resulting mean and maximum doses to the PTV were 1268 and 1465cGy for VoLO and 1284 and 1541cGy for Eclipse, respectively. For 5 of 6 OAR structures the VoLO system achieved lower mean and D10 doses ranging from 22% to 52% and 3% to 44%, respectively. Total computational time including only optimization and dose calculation were 0.9 hours for VoLO and 3.8 hours for Eclipse. These times do not include user-dependent target delineation and field setup. Both planning systems are capable of creating high-quality plans for total marrow irradiation. The VoLO planning system was able to achieve more uniform dose distribution throughout the target volume and steeper dose fall off, resulting in superior OAR sparing. VoLO׳s graphics processing unit (GPU)-based optimization and dose calculation algorithm also allowed much faster creation of TMI plans.
authors.affiliation: Karmanos Cancer Center, Detroit, MI. Electronic address: nalichoa@karmanos.org.
authors.forename: Adrian
authors.initials: A
authors.lastname: Nalichowski
authors.affiliation: Wayne State University School of Medicine, Detroit, MI.
authors.forename: Don G
authors.initials: DG
authors.lastname: Eagle
authors.affiliation: Karmanos Cancer Center, Detroit, MI; Wayne State University School of Medicine, Detroit, MI.
authors.forename: Jay
authors.initials: J
authors.lastname: Burmeister
mesh_terms: D001853:Bone Marrow / Q000528:radiation effects*; D006801:Humans; D058958:Organs at Risk; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D047368:Tumor Burden
keywords: Hematologic malignancies; Plan quality; Planning efficiency; TBI; TMI; Total body irradiation; Total marrow irradiation