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Tomotherapy in malignant mesothelioma: a planning study to establish dose constraints

Tomotherapie bei malignem Pleuramesotheliom: eine Planungsstudie zur Etablierung von Dosisbeschränkungen

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Abstract

Purpose

A planning study was performed for helical tomotherapy treatment. We evaluated the maximum achievable protection of organs at risk (OARs) in patients with malignant pleural mesothelioma after pleurectomy with simultaneous optimal target coverage.

Materials and methods

The datasets of 13 patients were included. The applied dose to the planning target volume (PTV) was 50.4 Gy with single doses of 1.8 Gy per fraction. Presuming optimal target coverage, we evaluated the applied dose to the OARs with special regard to the contralateral lung.

Results

For left-(lsRT)/right(rsRT)-sided radiotherapy, target coverage for the PTV showed a D98 (mean) of 49.37/49.71 Gy (98.0%/98.6%) and a D2 (mean) of 54.19/54.61 Gy (107.5%/108.3%). The beam-on time was kept below 15 min. The achieved mean dose (D50) to the contralateral lung was kept below 4 Gy for lsRT and rsRT. With regard to the other organs at risk the applied doses were as follows: mean dose (lsRT): ipsilateral kidney (Dmean) 13.03 (5.32–22.18) Gy, contralateral kidney (Dmean) <2.0 Gy, heart (Dmean) 22.23 (13.57–27.72) Gy, spinal cord D1 <Gy; mean dose (rsRT): ipsilateral kidney (Dmean) 10.22 (6.30–18.04) Gy, contralateral kidney (Dmean) <2.1 Gy, heart (Dmean) 8.02 (6.0–10.38) Gy, spinal cord D1 <35.5 Gy.

Conclusion

With helical tomotherapy, postoperative treatment for malignant pleural mesothelioma after pleurectomy achieves good target coverage combined with simultaneous dose sparing to the (especially contralateral) OARs.

Zusammenfassung

Zielsetzung

Planungsstudie zur Behandlung von Pleuramesotheliomen mittels helikaler Tomotherapie. Analysiert wurde die maximal mögliche Schonung der Risikoorgane (OARs) für Bestrahlungen bei Patienten mit einem malignen Pleuramesotheliom nach Pleurektomie bei gleichzeitig guter Zielvolumenabdeckung.

Material und Methoden

Die Datensätze von 13 Patienten wurden analysiert. Die für das Planungszielvolumen (PTV) verschriebene Dosis lag bei 50,4 Gy mit Einzeldosen von 1,8 Gy. Unter der Voraussetzung einer guten Zielvolumenabdeckung wurde die im Bereich der OARs erreichte Dosis insbesondere im Bereich der kontralateralen Lunge evaluiert.

Ergebnisse

Für links-/rechtsseitige Bestrahlungen lag die Zielvolumenabdeckung im PTV für die D98 im Mittel bei 49,37/49,71 Gy (98,0 %/98,6 %) und für die D2 bei 54,19/54,61 Gy (107,5 %/108,3 %). Die Bestrahlungszeit lag unter 15 min. Die im Bereich der kontralateralen Lunge erreichte mediane Dosis (D50) lag im Mittel sowohl für linksseitige (lsRT) als auch für rechtsseitige (rsRT) Bestrahlungen unter 4 Gy. Im Bereich der anderen OARs lag die applizierte Dosis jeweils bei: – mittlere Dosis (lsRT): ipsilaterale linke Niere (Dmean) 13,03 (5,32–22,18) Gy, kontralaterale Niere (Dmean) <2,0 Gy, Herz (Dmean) 22,23 (13,57–27,72) Gy, Rückenmark D1 <35 Gy; – mittlere Dosis (rsRT): ipsilaterale rechte Niere (Dmean) 10,22 (6,30–18,04) Gy, kontralaterale Niere (Dmean) <2,1 Gy, Herz (Dmean) 8,02 (6,0–10,38) Gy, Rückenmark D1 <35,5 Gy.

Schlussfolgerung

Durch eine postoperative Bestrahlung mit helikaler Tomotherapie bei malignen Pleuramesotheliomen nach Pleurektomie kann eine gute Dosisabdeckung im Zielvolumen kombiniert mit der Schonung der (insbesondere kontralateralen) OARs erreicht werden.

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Notes

  1. D1/2/5/50/98/99: radiation dose encompassing 1/2/5/50/98/99% of the volume/organ.

    Dmax/mean: maximal/mean dose exposure of the volume/organ.

    V5/20: percent per volume (of the organ) receiving more than 5/20 Gy.

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Authors and Affiliations

  1. Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Christina Leitzen, Timo Wilhelm-Buchstab, Sabina Stumpf, Martina Heimann, David Koch, Christopher Schmeel, Birgit Simon, Susanne Vornholt, Stephan Garbe, Fred Röhner, Felix Schoroth, Hans Heinz Schild, Heinrich Schüller & Thomas Müdder

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  1. Christina Leitzen
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  2. Timo Wilhelm-Buchstab
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  14. Thomas Müdder
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Correspondence to Christina Leitzen.

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Conflict of interest

C. Leitzen, T. Wilhelm-Buchstab, S. Stumpf, M. Heimann, D. Koch, C. Schmeel, B. Simon, S. Vornholt, S. Garbe, F. Röhner, F. Schoroth, H.H. Schild, H. Schüller, and T. Müdder declare that they have no competing interests.

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The accompanying manuscript does not include studies on humans or animals.

Additional information

The authors C. Leitzen and T. Wilhelm-Buchstab contributed equally to the manuscript.

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Leitzen, C., Wilhelm-Buchstab, T., Stumpf, S. et al. Tomotherapy in malignant mesothelioma: a planning study to establish dose constraints. Strahlenther Onkol 195, 668–676 (2019). https://doi.org/10.1007/s00066-019-01458-1

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  • DOI: https://doi.org/10.1007/s00066-019-01458-1

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