The implementation of low instantaneous dose rate total body irradiation with linear accelerator in small-size treatment rooms.

Autor: Gao Z; Department of Radiation Oncology, Shanghai Concord Medical Cancer center, Shanghai, China.; Proton & Heavy Ion Medical Research Center, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Soochow, Jiangsu, China., Xu Q; Department of Radiation Oncology, Shanghai Concord Medical Cancer center, Shanghai, China.; Proton & Heavy Ion Medical Research Center, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Soochow, Jiangsu, China., Zhang F; Department of Radiation Oncology, Shanghai Concord Medical Cancer center, Shanghai, China.; Proton & Heavy Ion Medical Research Center, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Soochow, Jiangsu, China., Hong Y; Department of Radiation Oncology, Shanghai Concord Medical Cancer center, Shanghai, China.; Proton & Heavy Ion Medical Research Center, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Soochow, Jiangsu, China., Hu Q; Department of Radiation Oncology, Shanghai Concord Medical Cancer center, Shanghai, China.; Proton & Heavy Ion Medical Research Center, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Soochow, Jiangsu, China., Yu Q; Department of Radiation Oncology, Shanghai Concord Medical Cancer center, Shanghai, China.; Proton & Heavy Ion Medical Research Center, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Soochow, Jiangsu, China., Fu S; Department of Radiation Oncology, Shanghai Concord Medical Cancer center, Shanghai, China.; Proton & Heavy Ion Medical Research Center, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Soochow, Jiangsu, China., Gong Q; Department of Radiation Oncology, Shanghai Concord Medical Cancer center, Shanghai, China.; Proton & Heavy Ion Medical Research Center, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Soochow, Jiangsu, China.
Jazyk: angličtina
Zdroj: Journal of applied clinical medical physics [J Appl Clin Med Phys] 2024 Nov; Vol. 25 (11), pp. e14502. Date of Electronic Publication: 2024 Sep 04.
DOI: 10.1002/acm2.14502
Abstrakt: Purpose: This paper describes the implementation of an instantaneous low-dose-rate total body irradiation (TBI) technique using block-filtered 6 MV X-rays with a linear accelerator (LINAC) to reduce pulmonary toxicity.
Methods: In the absence of dedicated TBI-specific meter-set dose rates in LINAC and sufficient treatment room size, a 2-cm-thick transmission block was used together with a 200-cm source-to-surface distance (SSD) to reduce the instantaneous dose rates of 6 MV x-rays down to 10 cGy/min, thus alteration to the beam properties. A TBI-specific dose calculation model was built with data acquired at the treatment planning system (TPS)-permitted maximum 140-cm SSD and was validated in phantoms at a 180-cm SSD. As for planning strategies, we adopted large anterior-to-posterior/posterior-to-anterior (AP/PA) open fields with multi-leaf collimator shielding for lungs to achieve target coverage, lung protection, and efficient dose delivery. A custom-designed sliding couch (Patent No. ZL202123085880.1) was manufactured to support patients during treatment. Measures to control the quality and safety of TBI treatment include machine interlocks, pretreatment checklists, and in-vivo dose monitoring.
Results: The instantaneous dose rate of block-filtered 6MV X-ray was reduced to approximately 7.0 cGy/min at 12.5-7.5 cm depth with a 185-200 cm SSD. The dose calculated by TPS differs from the measurements by 0.15%-1.55% in the homogeneous phantom and 1.2%-4.85% in the CIRS thorax phantom. The open-field TBI technique achieved V 90% (PTV) ≈ 96.8% and MLD = 6.6 Gy with 1-h planning and 50-min beam delivery in a single fraction. From February 2021 to July 2023, 30 patients received TBI treatments in our center, and in-vivo monitoring results differed from TPS calculations by -1.49%-2.10%. After 6-12 months of follow-ups, all the patients treated in our center showed no pulmonary toxicities of grade 2 or higher.
Conclusion: A low instantaneous dose rate TBI technique can be implemented in the clinic.
(© 2024 The Author(s). Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)
Databáze: MEDLINE
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