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Combining deep-inspiration breath hold and intensity-modulated radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma: Dosimetric evaluation using comprehensive plan quality indices

 Seo Hee Choi  ;  So Hyun Park  ;  Jason Joon Bock Lee  ;  Jong Geol Baek  ;  Jin Sung Kim  ;  Hong In Yoon 
 RADIATION ONCOLOGY, Vol.14(1) : 59, 2019 
Journal Title
Issue Date
Deep inspiration breath hold ; Intensity modulated radiotherapy ; Mucosa-associated lymphoid tissue lymphoma ; Planning study ; Radiotherapy
BACKGROUND: Although there have been many attempts to increase the therapeutic ratio of radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma (MALToma), only a few planning studies have reported the efficacy of the modern radiotherapy technique till date. Therefore, we performed the dosimetric comparison among 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) plans, using deep-inspiration breath hold (DIBH) or free-breathing (FB) techniques, to determine the most optimal plan for gastric MALToma.

METHODS: We evaluated 9 patients with gastric MALToma for whom 3D-CRT, step-and-shoot IMRT (SIMRT), volumetric-modulated arc therapy (VMAT), and tomotherapy plans with identical prescribed doses were generated using DIBH or FB computed tomography (CT). Planning target volume (PTV) coverage and non-target doses were calculated for each plan and compared with plan quality metric (PQM) scores.

RESULTS: All 72 plans of 9 patients satisfied our dosimetric goals, and the IMRT plans and 3D-CRT plans had similarly good conformity index values with no differences related to respiratory movement. IMRT plans yielded significantly better doses to the organs-at-risk, and DIBH plans yielded significantly lower liver, heart, and lung Dmean and spinal cord Dmax with smaller irradiated volumes compared to FB plans. For the mean PQM scores, VMAT-DIBH and SIMRT-DIBH yielded the best scores, whereas 3D plans provided reduced beam monitor unit values.

CONCLUSION: Our findings demonstrate that modern RT technologies (DIBH with VMAT or SIMRT) could potentially provide excellent target coverage for gastric MALToma while reducing doses to organs-at-risk. However, the relevance of the most optimal plan considering clinical outcomes should be confirmed further in a larger patient cohort.
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6. Others (기타) > Severance Hospital (세브란스병원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jinsung(김진성) ORCID logo https://orcid.org/0000-0003-1415-6471
Baek, Jong Geal(백종걸)
Yoon, Hong In(윤홍인) ORCID logo https://orcid.org/0000-0002-2106-6856
Choi, Seo Hee(최서희) ORCID logo https://orcid.org/0000-0002-4083-6414
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