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Partially ablative radiotherapy (PAR) for large mass tumors using simultaneous integrated boost: A dose-escalation
Savino Cilla1, Francesco Deodato2, Anna Ianiro1
1Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy.
Journal of Applied Clinical Medical Physics
|September 17, 2018
Summary
This study demonstrates that a modified simultaneous integrated boost (SIB) technique is feasible for delivering highly heterogeneous doses to large tumors using volumetric modulated arc therapy (VMAT). This approach improves dose distribution and spares healthy tissues in palliative radiotherapy.
Area of Science:
- Radiation Oncology
- Medical Physics
- Cancer Treatment
Background:
- Palliative radiotherapy for large, symptomatic tumors presents challenges in dose delivery.
- Volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) offers potential for complex dose distributions.
Observation:
- A modified SIB technique was applied to a patient with a large gluteal chordoma.
- Dual-arc VMAT plans were generated for accelerated, twice-daily fractionation over two days.
- Dose escalation to the boost target volume (BTV) was compared to sequential boost (SEQ) plans.
Findings:
- SIB plans showed superior dose contrast index (DCI), conformity index (CI), and integral dose (ID) compared to SEQ plans.
- Even with a 200% dose escalation to the BTV, SIB plans achieved a 66% DCI versus 37% for SEQ plans.
- SIB plans resulted in minimal (less than 2%) increase in healthy tissue irradiation at critical dose levels.
Implications:
- Modified SIB VMAT is a dosimetrically feasible technique for treating large tumors requiring heterogeneous, high-dose irradiation.
- This method can enhance therapeutic gain by delivering higher doses to tumors while sparing surrounding healthy tissues.
- The technique supports accelerated, short-course palliative radiotherapy regimens.
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