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1-1b_HRT1215-Session_HEGI_JOHNSON_WESTMEAD_NSW

Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012. Volumetric Modulated Arc Therapy for Stereotactic Body Radiotherapy in Early Lung Cancer. Dr Fiona Hegi-Johnson. Westmead Hospital. 1-1b_HRT1215-Session_HEGI_JOHNSON_WESTMEAD_NSW. KEY PROBLEM.

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1-1b_HRT1215-Session_HEGI_JOHNSON_WESTMEAD_NSW

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  1. Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Volumetric Modulated Arc Therapy for Stereotactic Body Radiotherapy in Early Lung Cancer.Dr Fiona Hegi-Johnson Westmead Hospital 1-1b_HRT1215-Session_HEGI_JOHNSON_WESTMEAD_NSW

  2. KEY PROBLEM Stereotactic body radiotherapy(SBRT) for early lung cancer results in excellent local control and potentially improved survival1. 3D-conformal radiotherapy(3D-CRT) and intensity modulated radiation therapy( IMRT) delivery require long treatment times, increasing the risk of patient motion. Volumetric arc therapy(VMAT) may result in improved dosimetric outcomes, and potentially reduced treatment time. 1. Chi et al. Radiotherapy and Oncology 94(2010): 1-11

  3. AIM OF THIS INNOVATION Assess dosimetric outcomes of implementing VMAT for SBRT lung Quantify time required for treatment of SBRT lung patients

  4. BASELINE DATA Stereotactic Body Radiotherapy (SBRT) lung: Very small volumes treated to high doses ( typically 48-54 Gy in 3-5 fractions) Demands high conformality of radiotherapy dose, with rapid fall-off from high dose region Previous techniques in use: 3D-Conformal radiotherapy Intensity modulated radiotherapy Use 10-12 beams, often requiring non-coplanar beams Up to 1 hour in treatment time Uncomfortable for patients, and increases the risk of tumour motion during treatment.

  5. KEY CHANGES IMPLEMENTED Pinnacle VMAT plans compared to coplanar (CP) and non-coplanar (NCP) 3D-CRT and IMRT plans for delivery on Elekta Linacs and assessed for: Target coverage with the prescribed dose and 98% coverage of the PTV Low dose wash at 2 cm from target V20 (volume of normal lung receiving 20 Gy). 3 patients included All patients received 48 Gy in 4 fractions given twice weekly.

  6. KEY CHANGES IMPLEMENTED

  7. KEY CHANGES IMPLEMENTED Clinical treatment time: 35 minutes

  8. OUTCOMES SO FAR VMAT demonstrated to improve target coverage compared other techniques (>98% vs. 94-97%) V20 higher with VMAT 6% vs. 4.1-5.6%. Low dose wash superior to 3D-CRT (Co-planar and non-coplanar) and co-planar IMRT. Treatment time reduced to 35 minutes.

  9. LESSONS LEARNT Choice of radiotherapy technique: Consider technical factors Ease of implementation Need for further training Future considerations: VMAT funding significantly lower than other techniques, as reimbursement is based on the number of beams, and fractions delivered. Currently under negotiation, but may make this expensive for departments to implement.

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