Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases

Purpose/ObjectivesTo perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases.Methods/MaterialsDiagnostic comput...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Davide Scafa, Thomas Muedder, Jasmin A. Holz, David Koch, Younéss Nour, Stephan Garbe, Maria A. Gonzalez-Carmona, Georg Feldmann, Tim O. Vilz, Mümtaz Köksal, Frank A. Giordano, Leonard Christopher Schmeel, Gustavo R. Sarria
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	SRS IORT kilovoltage liver metastases intraoperative Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/54b6e3c1a79d4658a6e712651bdd8860
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:54b6e3c1a79d4658a6e712651bdd8860
record_format	dspace
spelling	oai:doaj.org-article:54b6e3c1a79d4658a6e712651bdd88602021-12-02T05:34:05ZDosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases2234-943X10.3389/fonc.2021.767468https://doaj.org/article/54b6e3c1a79d4658a6e712651bdd88602021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.767468/fullhttps://doaj.org/toc/2234-943XPurpose/ObjectivesTo perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases.Methods/MaterialsDiagnostic computed tomographies (CT) of patients carrying one or two lesions <4 cm and who underwent surgery were retrospectively screened and randomly selected for the study. For DIBH-SRS, a gross target volume (GTV) plus planning target volume (PTV) were delineated. For FB-SRS, a GTV plus an internal target volume (ITV) and PTV were defined. Accounting for the maximal GTV diameters, a modified GTV (GTV-IORT) was expanded circumferentially to simulate a resection cavity. The best suitable round-applicator size was thereafter selected. All treatment plans were calculated homogeneously to deliver 40 Gy. Doses delivered to organs at risk (OAR) and target volumes were compared for IORT vs. both SRS modalities.ResultsEight patients encompassing 10 lesions were included in the study. The mean liver volume was 2,050.97 cm3 (SD, 650.82), and the mean GTV volume was 12.23 cm3 (SD, 12.62). As for target structures, GTV-IORT [19.44 cm3 (SD, 17.26)] were significantly smaller than both PTV DIBH-SRS [30.74 cm3 (SD, 24.64), p = 0.002] and PTV FB-SRS [75.82 cm3 (SD, 45.65), p = 0.002]. The median applicator size was 3 cm (1.5–4.5), and the mean IORT simulated delivery time was 45.45 min (SD, 19.88). All constraints were met in all modalities. Liver V9.1 showed significantly smaller volumes with IORT [63.39 cm3 (SD, 35.67)] when compared to DIBH-SRS [150.12 cm3 (SD, 81.43), p = 0.002] or FB-SRS [306.13 cm3 (SD, 128.75), p = 0.002]. No other statistical or dosimetrically relevant difference was observed for stomach, spinal cord, or biliary tract. Mean IORT D90 was 85.3% (SD, 6.05), whereas D95 for DIBH-SRS and FB-SRS were 99.03% (SD, 1.71; p = 0.042) and 98.04% (SD, 3.46; p = 0.036), respectively.ConclusionKilovoltage IORT bears the potential as novel add-on treatment for resectable liver metastases, significantly reducing healthy liver exposure to radiation in comparison to SRS. Prospective clinical evidence is required to confirm this hypothesis.Davide ScafaThomas MuedderJasmin A. HolzDavid KochYounéss NourStephan GarbeMaria A. Gonzalez-CarmonaGeorg FeldmannTim O. VilzMümtaz KöksalFrank A. GiordanoLeonard Christopher SchmeelGustavo R. SarriaFrontiers Media S.A.articleSRSIORTkilovoltageliver metastasesintraoperativeNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	SRS IORT kilovoltage liver metastases intraoperative Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	SRS IORT kilovoltage liver metastases intraoperative Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Davide Scafa Thomas Muedder Jasmin A. Holz David Koch Younéss Nour Stephan Garbe Maria A. Gonzalez-Carmona Georg Feldmann Tim O. Vilz Mümtaz Köksal Frank A. Giordano Leonard Christopher Schmeel Gustavo R. Sarria Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases
description	Purpose/ObjectivesTo perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases.Methods/MaterialsDiagnostic computed tomographies (CT) of patients carrying one or two lesions <4 cm and who underwent surgery were retrospectively screened and randomly selected for the study. For DIBH-SRS, a gross target volume (GTV) plus planning target volume (PTV) were delineated. For FB-SRS, a GTV plus an internal target volume (ITV) and PTV were defined. Accounting for the maximal GTV diameters, a modified GTV (GTV-IORT) was expanded circumferentially to simulate a resection cavity. The best suitable round-applicator size was thereafter selected. All treatment plans were calculated homogeneously to deliver 40 Gy. Doses delivered to organs at risk (OAR) and target volumes were compared for IORT vs. both SRS modalities.ResultsEight patients encompassing 10 lesions were included in the study. The mean liver volume was 2,050.97 cm3 (SD, 650.82), and the mean GTV volume was 12.23 cm3 (SD, 12.62). As for target structures, GTV-IORT [19.44 cm3 (SD, 17.26)] were significantly smaller than both PTV DIBH-SRS [30.74 cm3 (SD, 24.64), p = 0.002] and PTV FB-SRS [75.82 cm3 (SD, 45.65), p = 0.002]. The median applicator size was 3 cm (1.5–4.5), and the mean IORT simulated delivery time was 45.45 min (SD, 19.88). All constraints were met in all modalities. Liver V9.1 showed significantly smaller volumes with IORT [63.39 cm3 (SD, 35.67)] when compared to DIBH-SRS [150.12 cm3 (SD, 81.43), p = 0.002] or FB-SRS [306.13 cm3 (SD, 128.75), p = 0.002]. No other statistical or dosimetrically relevant difference was observed for stomach, spinal cord, or biliary tract. Mean IORT D90 was 85.3% (SD, 6.05), whereas D95 for DIBH-SRS and FB-SRS were 99.03% (SD, 1.71; p = 0.042) and 98.04% (SD, 3.46; p = 0.036), respectively.ConclusionKilovoltage IORT bears the potential as novel add-on treatment for resectable liver metastases, significantly reducing healthy liver exposure to radiation in comparison to SRS. Prospective clinical evidence is required to confirm this hypothesis.
format	article
author	Davide Scafa Thomas Muedder Jasmin A. Holz David Koch Younéss Nour Stephan Garbe Maria A. Gonzalez-Carmona Georg Feldmann Tim O. Vilz Mümtaz Köksal Frank A. Giordano Leonard Christopher Schmeel Gustavo R. Sarria
author_facet	Davide Scafa Thomas Muedder Jasmin A. Holz David Koch Younéss Nour Stephan Garbe Maria A. Gonzalez-Carmona Georg Feldmann Tim O. Vilz Mümtaz Köksal Frank A. Giordano Leonard Christopher Schmeel Gustavo R. Sarria
author_sort	Davide Scafa
title	Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases
title_short	Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases
title_full	Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases
title_fullStr	Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases
title_full_unstemmed	Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases
title_sort	dosimetric comparison of intraoperative radiotherapy and srs for liver metastases
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/54b6e3c1a79d4658a6e712651bdd8860
work_keys_str_mv	AT davidescafa dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT thomasmuedder dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT jasminaholz dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT davidkoch dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT younessnour dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT stephangarbe dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT mariaagonzalezcarmona dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT georgfeldmann dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT timovilz dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT mumtazkoksal dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT frankagiordano dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT leonardchristopherschmeel dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases AT gustavorsarria dosimetriccomparisonofintraoperativeradiotherapyandsrsforlivermetastases
_version_	1718400351744294912

Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases

Ejemplares similares