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Open Access Research

Accelerated large volume irradiation with dynamic Jaw/Dynamic Couch Helical Tomotherapy

Sonja Krause1*, Sebastian Beck1, Kai Schubert1, Steffen Lissner1, Susanta Hui2, Klaus Herfarth1, Juergen Debus1 and Florian Sterzing1

Author Affiliations

1 Department of Radiation Oncology, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany

2 Department of Therapeutic Radiology, University of Minnesota, 420 Delaware St. SE, Mayo Mail Code 494, Minneapolis, , MN 55455, USA

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Radiation Oncology 2012, 7:191  doi:10.1186/1748-717X-7-191

Published: 12 November 2012

Abstract

Background

Helical Tomotherapy (HT) has unique capacities for the radiotherapy of large and complicated target volumes. Next generation Dynamic Jaw/Dynamic Couch HT delivery promises faster treatments and reduced exposure of organs at risk due to a reduced dose penumbra.

Methods

Three challenging clinical situations were chosen for comparison between Regular HT delivery with a field width of 2.5 cm (Reg 2.5) and 5.0 cm (Reg 5.0) and DJDC delivery with a maximum field width of 5.0 cm (DJDC 5.0): Hemithoracic Irradiation, Whole Abdominal Irradiation (WAI) and Total Marrow Irradiation (TMI). For each setting, five CT data sets were chosen, and target coverage, conformity, integral dose, dose exposure of organs at risk (OAR) and treatment time were calculated.

Results

Both Reg 5.0 and DJDC 5.0 achieved a substantial reduction in treatment time while maintaining similar dose coverage. Treatment time could be reduced from 10:57 min to 3:42 min / 5:10 min (Reg 5.0 / DJDC 5.0) for Hemithoracic Irradiation, from 18:03 min to 8:02 min / 8:03 min for WAI and to 18:25 min / 18:03 min for TMI. In Hemithoracic Irradiation, OAR exposure was identical in all modalities. For WAI, Reg 2.5 resulted in lower exposure of liver and bone. DJDC plans showed a small but significant increase of ∼ 1 Gy to the kidneys, the parotid glans and the thyroid gland. While Reg 5.0 and DJDC were identical in terms of OAR exposure, integral dose was substantially lower with DJDC, caused by a smaller dose penumbra.

Conclusions

Although not clinically available yet, next generation DJDC HT technique is efficient in improving the treatment time while maintaining comparable plan quality.

Keywords:
Dynamic jaw/dynamic couch; Helical tomotherapy; Large volumes; Hemithoracic irradiation; Whole abdominal irradiation; Total marrow irradiation