Treatment Time Reduction In Extracranial Radiosurgery Procedures Using A New Commercially Available Software

Purpose/ Objective(s): RapidArc is a new algorithm recently developed to deliver highly focused Intensity Modulated Radiation Therapy. The purposes of this retrospective review are: 1) To determine if extracranial radiosurgery treatments could be delivered in shortened times in comparison with conventional IMRT while maintaining precision in high dose target delivery. 2) Compare the monitor units (MU) required to deliver the treatment in comparison with traditional IMRT. 3) To analyze our initial results with Stereotactic Body Radiation Therapy (SBRT) using RapidArc combined with image guided radiotherapy (IGRT).Materials/MethodsBetween October 2008 and March 2010, 45 patients were treated with Stereotactic Body Radiosurgery using RapidArc with single or multiple arcs, coplanar or non coplanar. Twenty-seven patients were treated with SBRT only and 18 patients received SBRT boost following conventional external beam fractionation. Planning was done with commercially available software using CT, MRI and PET-CT fusion depending on the diagnosis of the primary tumor. The following sites were included: head and neck cancer (7 patients), gynecological tumors (10 patients), spine (9 patients), primary and metastatic lung cancer (7 patients), liver metastases (6 patients), and miscellaneous (6 patients). The number of radiosurgical procedures per patient ranged from 3 to 5. Dose per fraction ranged from 5 to 18 Gy with an average of 6.25 Gy and a median of 7 Gy. Individual treatment times ranged from 1.45 to 7.0 minutes. Early toxicity and patient tolerance were evaluated.ResultsAll treatment times were 7 minutes or less per patient ranging from 1.5 to 7 minutes. The amount of monitor units used was significantly reduced with RapidArc plans compared to IMRT for the same prescription dose. Three patients had grade I toxicity consisting of mild dysphagia. These patients were receiving treatment boost and in all 3 the target was in proximity to the esophagus.ConclusionsTreatment delivery for extracranial radiosurgery using Rapid Arc was significantly shorter than with conventional IMRT. Less monitor units were required. Treatment was well tolerated with minimal acute toxicity. Purpose/ Objective(s): RapidArc is a new algorithm recently developed to deliver highly focused Intensity Modulated Radiation Therapy. The purposes of this retrospective review are: 1) To determine if extracranial radiosurgery treatments could be delivered in shortened times in comparison with conventional IMRT while maintaining precision in high dose target delivery. 2) Compare the monitor units (MU) required to deliver the treatment in comparison with traditional IMRT. 3) To analyze our initial results with Stereotactic Body Radiation Therapy (SBRT) using RapidArc combined with image guided radiotherapy (IGRT). Materials/MethodsBetween October 2008 and March 2010, 45 patients were treated with Stereotactic Body Radiosurgery using RapidArc with single or multiple arcs, coplanar or non coplanar. Twenty-seven patients were treated with SBRT only and 18 patients received SBRT boost following conventional external beam fractionation. Planning was done with commercially available software using CT, MRI and PET-CT fusion depending on the diagnosis of the primary tumor. The following sites were included: head and neck cancer (7 patients), gynecological tumors (10 patients), spine (9 patients), primary and metastatic lung cancer (7 patients), liver metastases (6 patients), and miscellaneous (6 patients). The number of radiosurgical procedures per patient ranged from 3 to 5. Dose per fraction ranged from 5 to 18 Gy with an average of 6.25 Gy and a median of 7 Gy. Individual treatment times ranged from 1.45 to 7.0 minutes. Early toxicity and patient tolerance were evaluated. Between October 2008 and March 2010, 45 patients were treated with Stereotactic Body Radiosurgery using RapidArc with single or multiple arcs, coplanar or non coplanar. Twenty-seven patients were treated with SBRT only and 18 patients received SBRT boost following conventional external beam fractionation. Planning was done with commercially available software using CT, MRI and PET-CT fusion depending on the diagnosis of the primary tumor. The following sites were included: head and neck cancer (7 patients), gynecological tumors (10 patients), spine (9 patients), primary and metastatic lung cancer (7 patients), liver metastases (6 patients), and miscellaneous (6 patients). The number of radiosurgical procedures per patient ranged from 3 to 5. Dose per fraction ranged from 5 to 18 Gy with an average of 6.25 Gy and a median of 7 Gy. Individual treatment times ranged from 1.45 to 7.0 minutes. Early toxicity and patient tolerance were evaluated. ResultsAll treatment times were 7 minutes or less per patient ranging from 1.5 to 7 minutes. The amount of monitor units used was significantly reduced with RapidArc plans compared to IMRT for the same prescription dose. Three patients had grade I toxicity consisting of mild dysphagia. These patients were receiving treatment boost and in all 3 the target was in proximity to the esophagus. All treatment times were 7 minutes or less per patient ranging from 1.5 to 7 minutes. The amount of monitor units used was significantly reduced with RapidArc plans compared to IMRT for the same prescription dose. Three patients had grade I toxicity consisting of mild dysphagia. These patients were receiving treatment boost and in all 3 the target was in proximity to the esophagus. ConclusionsTreatment delivery for extracranial radiosurgery using Rapid Arc was significantly shorter than with conventional IMRT. Less monitor units were required. Treatment was well tolerated with minimal acute toxicity. Treatment delivery for extracranial radiosurgery using Rapid Arc was significantly shorter than with conventional IMRT. Less monitor units were required. Treatment was well tolerated with minimal acute toxicity.