Highlights
- •Estimation of delivered dose to lung tumours in SBRT considering geometrical errors.
- •Quantitative estimates, on statistical basis, of delivered tumour dose.
- •Estimation of difference between two IGRT methods extensively used in SBRT.
- •Illustration of a framework for carrying out estimates of delivered dose.
- •Online cone-beam CT image-guidance typically leads to higher tumour dose.
Abstract
Introduction
Dose-response relationships for local control of lung tumours treated with stereotactic
body radiotherapy (SBRT) have proved ambiguous, however, these have been based on
the prescribed or planned dose. Delivered dose to the target may be a better predictor
for local control. In this study, the probability of the delivered minimum dose to
the clinical target volume (CTV) in relation to the prescribed dose was estimated
for a cohort of patients, considering geometrical uncertainties.
Materials and methods
Delivered doses were retrospectively simulated for 50 patients treated with SBRT for
lung tumours, comparing two image-guidance techniques: pre-treatment verification
computed tomography (IG1) and online cone-beam computed tomography (IG2). The prescribed
dose was typically to the 67% isodose line of the treatment plan. Simulations used
in-house software that shifted the static planned dose according to a breathing motion
and sampled setup/matching errors. Each treatment was repeatedly simulated, generating
a multiplicity of dose-volume histograms (DVH). From these, tumour-specific and population-averaged
statistics were derived.
Results
For IG1, the probability that the minimum CTV dose (D98%) exceeded 100% of the prescribed dose was 90%. With IG2, this probability increased
to 99%.
Conclusions
Doses below the prescribed dose were delivered to a considerably larger part of the
population prior to the introduction of online soft-tissue image-guidance. However,
there is no clear evidence that this impacts local control, when compared to previous
published data.
Keywords
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Article info
Publication history
Published online: June 24, 2021
Accepted:
June 14,
2021
Received in revised form:
June 10,
2021
Received:
November 18,
2020
Identification
Copyright
© 2021 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
