Abstract
Background/purposeTo establish regression models of physical and equivalent dose in 2 Gy per fraction (EQD2) plan parameters of two kinds of hybrid planning for stage III NSCLC.MethodsTwo kinds of hybrid plans named conventional fraction radiotherapy & stereotactic body radiotherapy (C&S) and conventional fraction radiotherapy & simultaneous integrated boost (C&SIB) were retrospectively made for 20 patients with stage III NSCLC. Prescription dose of C&S plans was 2 Gy × 30f for planning target volume of lymph node (PTVLN) and 12.5 Gy × 4f for planning target volume of primary tumor (PTVPT), while prescription dose of C&SIB plans was 2 Gy × 26f for PTVLN and sequential 2 Gy × 4f for PTVLN combined with 12.5 Gy × 4f for PTVPT. Regression models of physical and EQD2 plan parameters were established based on anatomical geometry features for two kinds of hybrid plans. The features were mainly characterized by volume ratio, min distance and overlapping slices thickness of two structures. The possibilities of regression models of EQD2 plan parameters were verified by spearman’s correlation coefficients between physical and EQD2 plan parameters, and the influence on the consistence of fitting goodness between physical and EQD2 models was investigated by the correlations between physical and EQD2 plan parameters. Finally, physical and EQD2 models predictions were compared with plan parameters for two new patients.ResultsPhysical and EQD2 plan parameters of PTVLN CI60Gy have shown strong positive correlations with PTVLN volume and min distance(PT to LN), and strong negative correlations with PTVPT volume for two kinds of hybrid plans. PTV(PT+LN) CI60Gy is not only correlated with above three geometry features, but also negatively correlated with overlapping slices thickness(PT and LN). When neck lymph node metastasis was excluded from PTVLN volume, physical and EQD2 total lung V20 showed a high linear correlation with corrected volume ratio(LN to total lung). Meanwhile, physical total lung mean dose (MLD) had a high linear correlation with corrected volume ratio(LN to total lung), while EQD2 total lung MLD was not only affected by corrected volume ratio(LN to total lung) but also volume ratio(PT to total lung). Heart D5, D30 and mean dose (MHD) would be more susceptible to overlapping structure(heart and LN). Min distance(PT to ESO) may be an important feature for predicting EQD2 esophageal max dose for hybrid plans. It’s feasible for regression models of EQD2 plan parameters, and the consistence of the fitting goodness of physical and EQD2 models had a positive correlation with spearman’s correlation coefficients between physical and EQD2 plan parameters. For total lung V20, ipsilateral lung V20, and ipsilateral lung MLD, the models could predict that C&SIB plans were higher than C&S plans for two new patients.ConclusionThe regression models of physical and EQD2 plan parameters were established with at least moderate fitting goodness in this work, and the models have a potential to predict physical and EQD2 plan parameters for two kinds of hybrid planning.
Highlights
Definitive concurrent chemoradiotherapy (CCRT) has been recommended as the standard treatment for unresectable or medically inoperable stage III non-small cell lung cancer (NSCLC) [1,2,3]
When neck lymph node metastasis was excluded from planning target volume (PTV) of LN (PTVLN) volume, V20 (Fig. 3c, d) and mean lung dose (MLD) of total lung showed high linear correlations with corrected volume ratio(LN to total lung) (R2 = 0.701, P < 0.001 and R2 = 0.703, P < 0.001 for C&S plans; R2 = 0.747, P < 0.001 and R2 = 0.730, P < 0.001 for C&simultaneous integrated boost (SIB) plans)
When heart was partially overlapped with PTVLN, heart D30 and mean heart dose (MHD) showed high correlations of S type function with volume ratio of overlapping structure(heart and LN) to PTVLN (RHLL) (Heart D30 = e8.11–0.024/RHLL, R2 = 0.767, P < 0.001; MHD = e7.677–0.017/RHLL, R2 = 0.708, P < 0.001 for C&S plans, and heart D 30 = e8.098–0.024/RHLL, R2 = 0.775, P < 0.001; MHD = e7.656–0.017/RHLL, R2 = 0.700, P < 0.001 for conventional fraction radiotherapy & simultaneous integrated boost (C&SIB) plans)
Summary
Definitive concurrent chemoradiotherapy (CCRT) has been recommended as the standard treatment for unresectable or medically inoperable stage III non-small cell lung cancer (NSCLC) [1,2,3]. Two studies did a detailed analysis about locoregional failure in stage III NSCLC treated by CFRT, and showed that PT recurrence occurred more often than LN recurrence [4, 5]. The results of the CHISEL trial [6] suggested that implement of stereotactic body radiotherapy (SBRT) to PT and CFRT to LN could improve control of PT and further improve control of the entire region with two distinct target volumes. SBRT is suitable for PT dose escalation as there is a certain distance between PT and LN which could allow for dose drop. Tighter margin of planning target volume (PTV) and steeper dose drop around PT could reduce the risk of toxicity events while accurate dose delivery to PT could be implemented
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