Single fraction computed tomography-guided high-dose-rate brachytherapy or stereotactic body radiotherapy for primary and metastatic lung tumors?

Mark K.H. Chan, Venus W.Y. Lee, Noriyuki Kadoya, Chi Leung Chiang, Matthew Y.P. Wong, Ronnie W.K. Leung, Steven Cheung, Oliver Blanck

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To provide a pilot dosimetric study of computed tomography (CT)-guided high-dose-rate (HDR) brachytherapy (BRT) and stereotactic body radiotherapy (SBRT) for primary and metastatic lung lesions. Material and methods: For nine lung primary and metastasis patients, 3D image-based BRT plan using a single virtual catheter was planned for 34 Gy in single fraction to the gross tumor volume (GTV) + 3 mm margin to account for tumor deformation. These plans were compared to margin-based (MB-) and robustness optimized (RO-) SBRT, assuming the same tumor deformation under real-time tumor tracking. Consistent dose calculation was ensured for both BRT and SBRT plans using the same class of collapsed cone convolution superposition algorithm. Plan quality metrics were compared by Friedman tests and Wilcoxon t-tests. Results and Conclusions: Brachytherapy plans showed significant higher GTV mean dose compared to MB-and RO-SBRT (122.2 Gy vs. 50.4 and 44.7 Gy, p < 0.05), and better dose gradient index (R50) = 2.9 vs. 4.3 and 8.4 for MB-and RO-SBRT, respectively. Dose constraints per the RTOG 0915 protocol were achieved for all critical organs except chest wall in BRT. All other dose-volume histograms (DVH) metrics are comparable between BRT and SBRT. Treatment delivery time of BRT and SBRT plans significantly increased and decreased with increasing GTV size, respectively. SBRT using advanced MLC tracking technique and non-coplanar VMAT can achieve comparable dosimetric quality to HDR BRT. Whether or not, the significantly higher GTV dose can increase killing of radioresistant tumor cells and offset the effect of tumor reoxygenation in single fraction BRT, requires further clinical investigation.

Original languageEnglish
Pages (from-to)446-453
Number of pages8
JournalJournal of Contemporary Brachytherapy
Volume10
Issue number5
DOIs
Publication statusPublished - 2018

Keywords

  • CT-guided brachy
  • HDR
  • High-dose-rate
  • Lung cancer
  • Metastasis
  • Stereotactic body radiotherapy.

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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