Implementation of Novel Treatment Planning Strategies to Reduce Cardiac Dose in Locally Advanced Non-Small Cell Lung Cancer Patients
Recommended Citation
Kim JP, Dewalt J, Feldman A, Adil K, Movsas B, Chetty I. Implementation of Novel Treatment Planning Strategies to Reduce Cardiac Dose in Locally Advanced Non-Small Cell Lung Cancer Patients. Med Phys 2022; 49(6):e293.
Document Type
Conference Proceeding
Publication Date
6-1-2022
Publication Title
Med Phys
Abstract
Purpose: For locally advanced, non-small cell lung cancer (NSCLC) patients, recent trials have demonstrated the importance of limiting cardiac dose without sacrificing target coverage or significantly increasing lung dose. To accomplish these goals, a set of novel treatment planning strategies were designed and evaluated. Methods: Three novel planning strategies were retrospectively implemented for a set of 20 previously treated, locally advanced, NSCLC patients originally prescribed to 60-66Gy that received a mean heart dose (MHD) ≥ 10 Gy. Of the planning strategies, the first was a multi-isocentric arc-based approach (Heart-MI) utilizing two isocenters at least 10cm apart longitudinally. The second was a non-coplanar, arc-based approach (Heart-NCP) that added a set of up to three large couch angles combined with short anterior arcs to a standard arc at a couch angle of 0. The last utilized a hybrid approach (Heart-HYBRID) that implemented the Heart-NCP strategy for 2/3 of treatment fractions and an oppositeopposed planning strategy angled to avoid the heart for the remaining fractions. Results: Target coverage was maintained, and non-heart organ-at-risk doses were kept within prescribed levels. With respect to cardiac dose reduction, there were statistically significant decreases in Heart V30, V50, and mean dose for the Heart-MI (6.2 vs. 13.1% (p<0.001), 2.3 vs. 3.3% (p=0.01), 9.8 vs. 15.4 Gy (p<0.001), respectively), Heart-NCP (5.8 vs. 13.1% (p<0.001), 2.2 vs. 3.3% (p=0.02), 9.2 vs. 15.4 Gy (p<0.001), respectively), and Heart-HYBRID (5.0 vs. 13.1% (p<0.001), 2.3 vs. 3.3% (p=0.02), 7.9 vs. 15.4 Gy (p<0.001), respectively) strategies. Conclusion: The Heart-NCP strategy represented the best compromise between cardiac dose reduction and maintaining plan quality metrics. Use of this strategy resulted in mean heart dose reductions of 37.6 + 12.9% (6.2 + 3.4 Gy) relative to original plans and brought mean heart dose below 10 Gy for 16 of 20 patients.
Volume
49
Issue
6
First Page
e293
