P05.14 Dosimetric Impact of Using the Acuros XB for Planning of SBRT of Centrally Located NSCLC

Abstract

Stereotactic Body Radiation Treatment (SBRT) of lung cancer is applied to a heterogeneous density gradient. Dose modeling is highly dependent on the accuracy of the calculation algorithm. This study aims to assess the dosimetric implications calculated by Acuros External Beam (AXB) instead of the Anisotropic Analytical Algorithm (AAA) in SBRT of centrally located-Non small cell lung cancer (CL-NSCLC). Twelve IMRT plans for SBRT of CL-NSCLC were investigated retrospectively. The prescribed scheme was 50 Gy in 5 fractions every 2 days. The plans originally calculated by AAA aimed to cover 95% PTV by varying prescription isodose lines at 70 to 90%. These plans were recalculated by AXB (Dose to medium) and verified by the benchmark Monte Carlo (MC) method. Dosimetric parameters e.g. V20Gy Lungs, D95%(PTV), D98%(GTV), dose gradient (the ratio of 50% prescription isodose volume to the PTV, R50%), and doses to organs at risk (spinal cord, heart, esophagus, trachea, bronchus, and major vessels) were compared. AAA has generally overestimated the PTV dose compared to AXB and MC. The mean differences for D95%(PTV) and D98%(GTV) is 3.1% and 2.8% higher than that of AXB, respectively. The differences were significant with p-value<0.05. They were further verified by MC method, the results agreed with that of AXB. The agreement between AXB and MC in all PTV parameters were within 1.6% and the differences were not significant. No significant differences were also noted on V20Gy Lungs between the three algorithms but three cases were observed with maximum point dose to the lung tissue 1cm surrounding the PTV increased over 11% after the recalculation of AXB. Moreover, two cases were reported exceeding in heart dose and three cases were found degrading from none to minor deviation in dose gradient R50%. AXB has been investigated intensively and found to perform superiorly to AAA especially in calculating the rapid change in heterogeneous density gradient e.g. in regions of re-buildup in soft tissue after passed through lung/air. Although AXB and MC have two completely different way in solving Linear Boltzmann Transport Equation (LBTE), the agreement between AXB and MC was widely acceptable, AXB provides an accurate but faster alternative to MC method. In this study, a significant under-dosage in PTV and large dose difference in modeling tissue/air interface were observed after remodeled with AXB and MC. Since the PTV of SBRT for NSCLC is relatively small, the PTV missed in AAA may lead to a reduction in treatment outcome. Hence, AXB should be used in preference to AAA to model SBRT for centrally located NSCLC.