Treatment planning system evaluation for mesothelioma IMRT

Area of Science:

• Radiation oncology
• Medical physics
• Thoracic surgery

Background:

• Malignant pleural mesothelioma (MPM) treatment often involves extrapleural pneumonectomy (EPP) followed by intensity-modulated radiation therapy (IMRT).
• IMRT offers improved dose distribution to the complex post-EPP surgical bed.
• Evaluating IMRT feasibility across different treatment planning systems is crucial for multi-institutional trials.

Observation:

• Treatment plans for MPM post-EPP were generated using Corvus, Eclipse, and Pinnacle systems with tissue heterogeneity corrections.
• All systems successfully calculated IMRT plans, optimizing for 50 Gy in 25 fractions to the clinical target volume.
• Dose distributions to critical organs and treatment efficiency metrics were assessed.

Findings:

• All three planning systems (Corvus, Eclipse, Pinnacle) could calculate IMRT plans for MPM.
• Corvus plans irradiated larger volumes of tissue to 60 Gy and required more monitor units and segments compared to Pinnacle and Eclipse.
• Dose constraints for organs at risk were met by all systems, with Pinnacle and Eclipse demonstrating greater efficiency.

Implications:

• IMRT is a viable radiation technique for MPM following EPP, calculable on common treatment planning systems.
• Pinnacle and Eclipse systems provide more efficient IMRT plan delivery, potentially reducing treatment time.
• Standardizing IMRT planning across institutions using systems like Pinnacle or Eclipse could facilitate multi-center studies for MPM.