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Heart-sparing volumetric modulated arc therapy for whole lung irradiation

Herzschonende volumetrische Bogenbestrahlung für die Ganzlungenbestrahlung

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Abstract

Purpose

Whole lung irradiation (WLI) is indicated for subgroups of patients with lung metastases from Wilms’ tumor (nephroblastoma). WLI has traditionally been performed with an anterior/posterior field arrangement with poor potential for heart sparing; thus, new techniques are desirable to achieve a lower dose to the heart.

Materials and methods

We utilized volumetric modulated arc therapy (VMAT) for WLI with 18 Gy in a patient with metastatic nephroblastoma. The planning results were compared against a three-dimensional (3D) conformal plan.

Results

VMAT resulted in adequate target volume coverage with the prescribed dose. Mean heart dose was 10.2 Gy. The dose to organs at risk (OAR) was generally more favorable with VMAT when compared with a 3D-conformal radiotherapy plan.

Discussion

WLI with VMAT provides superior sparing of OARs and especially a considerably lower dose to the heart.

Zusammenfassung

Ziel

Die Ganzlungenbestrahlung (GL-RT) ist indiziert bei Subgruppen von Patienten mit Lungenmetastasen eines Wilms-Tumors (Nephroblastom). Die GL-RT wird traditionell mit anterioren/posterioren Gegenfeldern durchgeführt und besitzt daher wenig Potenzial für eine Herzschonung. Um eine tiefere Herzdosis zu erreichen, sind neue Techniken wünschenswert.

Materialien und Methoden

Wir verwendeten eine volumetrische Bogenbestrahlung (VMAT) für eine GL-RT mit 18 Gy bei einem Patienten mit metastatischem Nephroblastom. Die Planungsresultate wurden mit einem 3‑D-konformalen Bestrahlungsplan verglichen.

Resultate

Die VMAT ergab eine adäquate Zielvolumenabdeckung mit der Verschreibungsdosis. Die mittlere Herzdosis betrug 10,2 Gy. Die Dosen an den Risikoorganen (OAR) waren generell besser mit VMAT im Vergleich zum 3‑D-konformalen Bestrahlungsplan.

Diskussion

GL-RT mit VMAT sorgt für eine bessere Schonung der OAR und speziell für eine deutlich tiefere Dosis am Herz.

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Correspondence to Alexandros Papachristofilou.

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A. Papachristofilou, A.-L. Hottinger, O. Weinhold, Y.-K. Avcu, T. Finazzi, T. Diesch and U. Schratzenstaller certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Papachristofilou, A., Hottinger, AL., Weinhold, O. et al. Heart-sparing volumetric modulated arc therapy for whole lung irradiation. Strahlenther Onkol 195, 77–82 (2019). https://doi.org/10.1007/s00066-018-1363-6

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  • DOI: https://doi.org/10.1007/s00066-018-1363-6

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