Capstone Research Paper Outline

Group7_2019

I. ABSTRACT
II. Introduction
A. Stereotactic body radiation therapy (SBRT) in the treatment of liver cancer or
metastases has been shown to be safe and provide excellent outcomes.1,2
1. SBRT treatment planning goals are to deliver the prescribed therapeutic
radiation dose to the planning target volume (PTV) and ensure rapid
dose fall-off from the PTV to provide needed organs at risk (OAR)
sparing.
2. Inherent risks of increased doses to organs at risk (OAR) are associated
with SBRT and special considerations must be made during treatment
planning.3
3. Dosimetric coverage of PTV is of paramount importance to achieve
goals of both local control (LC) and overall survival (OS).
4. Studies have shown superior outcomes in both LC and OS in patients
treated with liver SBRT when a biologically effective dose (BED 10Gy) of
100 Gy or more is delivered.4,5
5. Challenges in gaining adequate dosimetric coverage to PTV can arise
when surrounded by, include, or abut tissues of low density such as lung
parenchyma.
B. Differing dose calculation algorithms can result in disparate calculated doses of
both OAR and PTV which have the potential to make a clinical impact. 6
1. Although AAA is more widely used in clinical routine, Acuros XB has
been shown to more accurately model dose distributions, especially in
 3. Cakir8 studied dosimetric plan results with 10MV flattening filter free
(FFF) beams using Anisotropic Analytical Algorithm (AAA) and
Acuros XB calculation algorithms in the treatment of liver lesions and
the effect of calculation grid size.
4.
the liver dome which interface with lung tissue.
C. FFF beams have several advantages over flattening filter (FF) beams including an
increased dose rate factor of 2-4, decreased production of head scatter, and less
lateral transport due to a softer beam spectra.9
1. The dramatic increased dose rate of FFF beams in comparison to FF
beams enables a decrease in treatment delivery times with reduction in
OAR and PTV intra-fraction motion.
2. Additionally, patient comfort is enhanced with less time spent on the
treatment table.
D. FFF beams and the effects of OAR sparing and PTV coverage have been studied.
1. Yan et al10 found although PTV coverage was similar between 10MV
FFF and FF beams, differences in OAR sparing with FFF beam was
significant for some treatment sites.
2. In the SBRT treatment of liver lesions, an optimal 10 MV FFF beam
MLC margin surrounding PTV was investigated.
3. A study performed by Ogata et al11 identified the suitable multi-leaf
collimator (MLC) margins in patients treated with liver SBRT and
10MV FFF beams.
4. This study was limited in that an advanced calculation such as Acuros
XB7
reported to be at the dome of the liver with lung involvement.
 References
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10. Yan Y, Yadav P, Bassetti M, et al. Dosimetric differences in flattened and flattening
filter-free beam treatment plans. J Med Phys. 2016;41(2):92-99.
http://dx.doi.org/10.4103/0971-6203.181636.
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suitable leaf margin for liver stereotactic body radiotherapy with flattening filter-free
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