Impact of acceleration treatment on treatment plan and delivery qualities in tomotherapy for lung cancer

Acceleration treatment (AT) is a novel treatment planning parameter introduced in the tomotherapy-dedicated treatment planning system, Precision. This study explores the effects of AT on tomotherapy plans using helical (TomoHelical) and direct (TomoDirect) irradiation techniques.

This study enrolled 20 patients with lung cancer. Initially, 10 TomoHelical and 10 TomoDirect treatment plans were created for each patient, utilizing patient-specific field width and pitch with an AT setting of 0. These original plans were subsequently reoptimized by changing only the AT values to 1, 4, 7, and 10 without changing other calculation parameters to assess the impact of AT on dosimetric and delivery parameters. Additionally, the deliverability of all plans was evaluated through patient-specific quality assurance using gamma analysis.

Increasing the AT from 0 to 10 led to a slight increase in maximum doses and a decrease in minimum doses within the target volume, thereby impairing dose homogeneity. Dose conformity to the target also deteriorated. Conversely, target coverage and delivery time improved considerably with higher AT values. Moreover, doses to organs at risk, including the lung, spinal cord, heart, and esophagus, remained clinically acceptable across all plans. Changes in these doses and the gamma pass rate in patient-specific quality assurance were negligible with variations in AT. This trend was consistent across both delivery techniques.

AT is a crucial parameter in tomotherapy planning for modulating plan and delivery qualities. Higher AT values can enhance target coverage and delivery time efficiency.