To investigate the effect on PTV target coverage of liver VMAT SBRT treatment plans by varying the IMRT modulation factor (MF) and length of delivery time in the presence of induced respiratory motion.
Four different VMAT SBRT plans (MFs 2.1 to 3.5) were created for a liver phantom within the treatment planning system (Eclipse, Varian Oncology Systems). For each plan, the dose prescription was set to 5 different values (1000cGy to 5000cGy in 5 fractions); these variations force a change in the treatment delivery time due to reduce gantry speed required to deliver higher doses. To simulate respiratory motion, an in-house program was developed that shifts the positions of the MLC leaves at each control point according to population-based respiratory curves. This was done for 4 respiratory traces of comparable peak-to-peak amplitudes and breathing cycle lengths, with one trace exhibiting a baseline drift. A PTV margin of 5mm was used for all treatment plans.
A two-way repeatedmeasures ANOVA looked at changes in PTV V95 and GTV V95 coverage, based on IMRT factor and treatment time. The GTV V95 coverage and mean liver dose showed no significant difference (p values >0.05). The PTV V95 coverage showed a significant decrease with increasing IMRT factor and decreasing treatment time (p values < 0.01 for both). The patient curve with baseline drift exhibited a decrease in PTV coverage with increasing delivery time.
Decreased PTV coverage was seen with increasing modulation factor and decreasing treatment times for patients with regular breathing curves. With the advent of faster treatment times it is recommended that lower modulation factors for SBRT treatment plans be utilized to mitigate the possibility of interplay. Additionally, longer treatment times could be advantageous to blur out the interplay effect for SBRT treatments. Further investigation is required in patient plans.
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This article by E Hubley, G Pierce and G Ecclestone originally appeared on scitation.aip.org on June 26, 2015 at 08:09PM
