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Dose escalation in the definite target volume.

W Tyler Watkins1, Hamidreza Nourzadeh1, Jeffrey V Siebers1

  • 1Department of Radiation Oncology, University of Virginia, Charlottesville, VA, 22908, USA.

Medical Physics
|April 9, 2020
PubMed
Summary

This study introduces the definite target volume (DTV) for dose escalation in radiation therapy. The DTV approach allows for higher doses to subvolumes without significantly increasing organ at risk (OAR) dose, even with spatial uncertainties.

Keywords:
dose escalationgeometric uncertaintyradiation therapy

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Radiotherapy Planning

Background:

  • Accurate targeting in radiation therapy is crucial for dose escalation.
  • Spatial uncertainty in treatment delivery can limit the ability to deliver precise high doses.
  • Defining subvolumes within the clinical target volume (CTV) for dose escalation is an area of active research.

Purpose of the Study:

  • To introduce the definite target volume (DTV) concept.
  • To evaluate the dosimetric consequences of dose-escalating the DTV.
  • To assess the impact of spatial uncertainty on DTV dose escalation.

Main Methods:

  • Defined DTV using occupancy probability and CTV contraction.
  • Estimated margins for four treatment sites using image-guided radiation therapy (IGRT) literature.
  • Simulated dose escalation to the DTV, including spatial uncertainty effects (up to 130% violation).

Main Results:

  • DTV volumes ranged from 7.3 to 93.6 cc across different treatment sites.
  • Significant dose escalation was achieved in the DTV, with Dmax reaching up to 122.2 Gy (lung).
  • Increased OAR doses were minor (2.7 ± 2.1 Gy Dmean, 1.8 ± 2.2 Gy Dmax) even with spatial uncertainty, consistent with standard planning.

Conclusions:

  • The DTV concept enables extremely high doses to subvolumes within target volumes.
  • DTV-based dose escalation does not significantly increase OAR dose if spatial uncertainty is accurately estimated.
  • This method shows promise for improving radiotherapy outcomes across various treatment sites.